HomeMy WebLinkAboutDumpster Application & Permit - Permits - 20 HEMLOCK STREET 11/16/2016 The COMMOnweafth Of Massachusafts
Department of Hre Ser vgcsq
Office of the State Fire Marshag
P.0.Box 1025 State Road,Stow,MA o1775
APPLICATION FOR PERMIT
Date:
Permit No
—Ny or Town) ---7If Applicable Dig Safe Number
In accordance with the provisions of M.G.L. Chapter 1_0 as
provided' Section 527 CMR 34 application is hereby made Start Date
by
c
ull name person,F4irE�4--Z-C-)-�
in or Corporatio )
State clearly Address
purpose for
whiclipermit (Street or P.O.Box City or Town)
is requested Forpermissionto Locate dumpster for construction/renovation/demolition
Of structure
Comments; dumpster must be 25 ' from structure or covered when not in use-
at l fm 0
(Give location by street and no.,or describe in such manner as to provied adequate identification of�Iooation)
Name of competent operator Cert.NO,
(If Applicable)
Date Issued-rejected 13Y
(Signature of Applicant)
Date of expiration Fee$
------------- —---------------------------cut--------- --- ?aid Due
----------
The Commonwealth of
Massachusefts
Department of Fire Services
Office of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
Permit No PERMIT Date:
Z-JlCity ofoTown)/(- ----(If A�pplicable) . Dig Sa:&Nu7mber
In accordance with the provisions of M.G.L. Chapter 1 Oasprovidedia section 5 2 7 CMR 34
/I/- - ESta�Date
This Permit is granted to:
Full name of person,Firm or Corporation
Permission to locate dumpster f-or construction/renovation/demolition of structure
Comments:
Restrictions dumpster be 251 from structure or covered with tarp or plywood
at end of workday
at c�C) 4
(Give location by street and no,,or describe in such manner as to provied adequate identification of location)
Fee Paid 1-fo
This Permit will expire I-LEZ-2--) O�Iffic�ganting
(Signature 01 omcat granting permit
Title)
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