HomeMy WebLinkAboutDumpster Application & Permit - Permits - 373 RALEIGH TAVERN LANE 12/7/2016 The COMMOnvveafth of Massachusaft
Department of Five Sandcas
� mice of the 8 to Ffire Marshag
Q-
P-0--Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No
City or Town) ---TIf�Applic-able,) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter_ 1_0 as Safe N=7
provided in section 527 CMR 34
by cation is hereby made Start Date
(Full.name ofperson,Firm or Corporation)
State dearly Address -373 1;?,A-�- I�
purpose for (street orP_O-$ox City or Town)
whichpam2it
is requested FoTpermissionto Locate dumpster for constructi onlren ovation/d emolit ion
of structure
Comments: dumpster must be 25 from structure or covered when�not in use
at -2
Give location byTeet;and Eo,,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
--------------------- -------
The Commonwealth of Massachusetts
Department of Fire Services
Office of the State Fire Marshal
P.0,Box 1025 State Road,Stow,MA 01775 it
vot-lf—&_ Permit No PERM.1T Date: //J--—
(City of Town) ----(MA—pplicable Applicable) Dig Dig Safe Number
In accordance with the provisions of M.G.L. Chapter 10as provided in section 5 2 7 CMR 34
This Permit is granted to: 11�2-1 Start Date
Full name of person,Firm or Corporation
Pertnissionto 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
'Z'
2 y4 7
Give location by stri5�t and no.,or describe in such manner as to rovied adequ to identification of location
Fee Paid
This Permit will expire cal granting Offical granting permit
(Signnaature 0
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