HomeMy WebLinkAboutDumpster Application & Permit - Permits - 20 ROBINSON COURT 12/5/2016 The COMManweafth of Massachusetts
P�M
M M
Depanment of Five Services
F
Office of the State Fire Marshao
P.0.-Box 1025 State Road,Stow,MA o1775
APPLICATION FOR PERMIT
Date:
Permit No ----7If Applicable) Dig Dig Safe Nu-mber
—Tc—itFor Town) E
In accordance with the provisions of M.G1, Chapterl 1_0 as
provided in section 527 CMR 34 'ad
application is here�y made. Start Date
by
(Full name OfPersOnFirms orC0,5poration)
State clearly Address
"j
purpose for
Whichparmit (Street or R a Box City or Town)
is requested Forpermissionto Locate dumpster for construction/renovation/demolition ',�.,,
of structure
Comments: dumpster must be 25 ' from structure or covered whennot 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 Ceft NO.
(If Applicable)
h.
Date Issued rejectedBy
Date of expiration Fee Signature ofApplicant)
Paid Due
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The Coommonwealth of Massachusefts
Department of Fire Services
Office of the State are Marshai
P.0,Box 1025 State Road,Stow,MA 01775
/V PERMIT Date,
-,�l Permit No
City of—Town) ——— (If A—pphcable�) Dig Safe-N:,im—b:er
In accordance with the provisions of M.G.L. ChaPt —1 Oas provided in section 5 2 7 CMR 34 Start Date:
This Permit is granted to: iL ,ill gname 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 J—C) — 'L�
.' (Give location by street and no.,or describe in such manner as toprovied adequate identification of location)
Fee Paid S J-3 —
a-
1�1�grting�permit
This Permit will expire L
g
c granting permit (Title)
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