HomeMy WebLinkAboutDumpster Appliction & Permit - Permits - 35 COBBLESTONE CIRCLE 11/15/2016 The COMM051weafth of
Department of Fifes Services
Office of the State Fire Marshal
=� P.G.Box 1025 State Road,Stow,MA 01775
APPLICATIONFOR PERMIT
Date:
Permit No
(City or Town) (If Applicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter 10 as
provided inti 527 CMR 34 applica on is here made Start Date
by ,
(Full of son,Firm or Corp ation)
State clearly Address 11 a
purpose for (Street or P.O.Box City or Town)
which permit For permission to Locate dumpster for construction/renovation/demolition
is requested of s t r u c t u r e
Comments: dumpster must be 25 ' from structure or covered when not in use
at
(Give Iocatian by scree and na.,or describe in such manner as to pravied adequate identification of location)
Name of competent operator Cert.Na
(If Applicable)
Date Issued-rejected By
(Signature of plicant)
Date of expiration Fee$ / Paid Due
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The Commonwealth of Massachusetts
Department f Fire Services
Office of the State Firs Marshal
�~K P.C.Box 1025 State Road,Stow MA 01775
PERMIT
Permit No Date: A<//���
(City of Town) (If Applicable) :DigSafe N�unber
In accordance with the provisions of M.G.Z. Chapter 10asprovidedin section 5 2 7 CMR 34This Permit is granted to: Start D
Full name of person,Firm or Corporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 25 ' from structure or covered with tarp or plywood
Restrictions: at end of workday
at
(Give location by street and no.,or describe in such manner a o e u t dentiftcation of location)
Fee Paid$ �U
This Permit will expire �l Sgnature of o ffgcal ptim Officin � ;
ggpermt
(Title)
TWIA PPR IT MI[_QT RP rnK1_gp1r1 Inn Lq1 V Pn-QTr=n I IPr)K1 TW;= PP;= 1CJ=-q