HomeMy WebLinkAboutDumpster Application & Permit - Permits - 32 SOUTH CROSS ROAD 11/15/2016 The Commanweaflth of Masseat
QRPartment of Fire Sairvices
C)ff!CG Of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
k U"EY Or I own Permit No —
(ITApplicable) Dig Safe Number
In accordance with the
provisions
Chapter_._I D asprovided in�ecton ?2� CMR 34
----= &ppIication is h b i Date
by by Start F Date
Address LFull name
0 F' or Corpora A
State clearly Y1,7 �/�70,;
purpose for (Streator P.O.Box City or Town) All
which permit
is requested Forpeimissiontct Locate dumpster for construction/renovation/demolition *-,,
of structure
Comment : dumps I ter must e 25 ' from structure or covered—when not in useat
Give location by street and no.,or describe in such manner as to provied adequate identification of location
Name Of competent operator
(If Applicable) Cert.NO,
Date Issued-rejected By
expiration (Sigrtatur-ofAppli t)
Date of ex (Signature of Appli
Fee Paid
—------------------——--------- ——---—---—---------- -—----—-----——---—-------
The Commonwealth Of McIssachusefts
Department of Fire Services
Office of the State Fire Marshal
P.0.Box 1025 State Road,Stow;MA 01775
Rn do
Permit No PERMIT
Date: lAr -z
Ctty of To
wn)
———71f Applicable)——� Dig Safe 1k,rn b e r
In accordance with the provisions of M.G.L. Chapter. I Oas provided in section 5 2 7 CMR 34
This Permit is granted to: Start Date
Full name of person,Firm or Corporati n
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: d U D s t e r be 25 ' from structure or -
Restrictions: covered with tarp or plywood
Restrictions: a t end of workday
at
Fee Paid S (Give location by street and no.,or describe in such manner as to provied adequate identification of location)
This Permit will expire z2-�/J--
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