HomeMy WebLinkAboutDumpster Application & Permit - Permits - 790 DALE STREET 12/12/2016 The COMMOnweafth of Mazaachusefts
Department of Fire Services
Office Of the State Fire Mushag
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No
Tc—iFo—r�Town) I I""'0 ----TIf Applicable) Dig Safe Number
In accordance vdth the provisions of M.G.L. Chapter . 1
-r_— 1_0 as p li n
provided in section 527 CMR 34 application is hereby made 'Is StartDate
,ap]
by
(Full name ofperson.Firm or Corporation)
State clearly Address hn �d - - 1 , uh c)[q IC(
purpose for (Street orP.D.Box City or Town)
which permit Forpermissionto dumpster for construction/renovation/demolition -,��,
is requested of s --rucr-ure
Comments:—dumpster must be 2 ' from structure or covered when not in use
at (e�� D ,
(Giv6lbcation by street and no,,or describe in Sucihmarmer as�to prov��dade�quate identification�ofloca�tion)
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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The Commonwealth of Massachusetts
Department of Fire Services
Office of the State Fire Marshal
P.Q.Box 1025 State Road,Stoke,MA 01775 it
PERM,1T Date:
Per mit NO
---Tlf Applicable) DigSafeNumber'-
Ci of�T
Safe E&,tDat�ig
In accordance with the provisions of M.G.L Chapter 10as provided in section 5 2 7 CMR 34
This Permit is granted to: Start Date
Full name of person,Finn or Corporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 25 ' from structure or I
Restrictions: _LK covered with tarp or Plywood
at end of workday
at
((Give ocation by street and na,or describe in such manner as to provied adequate identification of location)
Fee Paid
This Permit will expire ZaZZ--Z 7 (Signature—
Imit TEN
0"�D
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