HomeMy WebLinkAboutDumpster Application & Permit - Permits - 52 WELLINGTON WAY 12/7/2016 The Commonwealth of Massachusafts
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PepaFtment of Firre seavices
Offics Of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA o1775
APPLICATION FOR PERMIT
Date:
Permit No 75�or Tovm) ---CH Applicable) Dig Safe Number
- �
In accordance with the provisions of M.G.L. Chapterj_�10 as
provided in section 527 CMR 34 application's hereby made Start Date
by
(Funn-ame ofperson,Firm or Corporation)
State clearly Address —-,-�-;� �2-�N ,-L
purpose,for
(Street orp.a Box City or Town)
which permit Forpertnissionto "Locate dumpster for construction/renovation/demolition
is requested of structure
Comments; dumpster must be 25 ' from structure or I 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) �2 " e?
Y�-�At'
Date Issued-rejected By
Signature of Applkant)���
Date of expiration Fee Paid
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The Commonwealth of Massachusetts
Department of it Services
OfflcG of the State it Marshal
P.0.Box 1025 State Road,Stow,MA 01775 it
PERM.IT Permit No Date: Z-1-
(City of Town) Dig Safe Numb
(If Applicable) Dig
In accordance with the provisions of M.G.L. Chapter 10as provided in section 5 2 7 CMR 34
This Permit is granted to: Ste Date,
Full name 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
(Give locat�ion bystrewe and no.,or describe in such manner as to provied adequate id tific 'on of location)u-, ,,, Oplov, (I adequate en a
a 0
Fee Paid
Z.-
.t) Of
This Permit wffl expire f (�Tin )
(Signature 11:1[ro ofL0ffl1cca!'1grant&ng manner
ofEic Wdngp
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