HomeMy WebLinkAboutDumpster Application & Permit - Permits - 50 HIGH STREET 11/16/2016 The COMMOnweafth of Massachusetts
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Pepartment of Fire ServQcea
Offics of the State Fire Marsh
P.0.J30X 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No
City or Town T— ---TIf Applic livable
PP Dig Safe Number
In accordance with the provisions of M.G1, Chapter_ 1_0 as
provided in Section 527 CMIZ 34
m-�Tplication is hereby made Start Date
by CZ1 V'f C— L—C— (f—
(Full name of person,Firm or Corporation)
State clearly Address 0 14 f /V,
purpose for (Street orl?.O.Box City arTown)
whichperrnit Forpermissionto Lo.f-ate dumpster for construction/renovation/demolition
is requested of structure
Comments; dumpster must be 2 from structure or covered when not in use
at
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Name of competent operator Cert.No,
(If Applicable)
Date Issued-rejected By
Signature of Applicant
Date of expiration Fee Paid Due
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V The Commonwealth of Massachusefts
Department of Fire Services
Office Of the State Fire Marshal
P.0,Box 1025 State Road,Stow,MA 01775 it
Permit No PERM.IT Date:
(City of Town) ---Flf Applicable) Dig—Dig Safe Number
In accordance with the provisions of M.G.L. Chapter 10 as provided in section 5 2 7 C M R 34
This Permit is granted to: Start Date
Full name of person,Firm or rporation
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 J-7)
(Give location b eet and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid
This Permit will expire C'Tlgn—aturl,—OfWgaraAnti"ngp--,,4f —0 �— -2��ifical granting permit (C—Title)
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