HomeMy WebLinkAboutDumpster Application & Permit - Permits - 50 CAMPBELL ROAD 12/8/2016 The COMMOn eafth of Massachusafts
C epaFtment of Fire Services
O 1cs of the State Fire Marshal
P.0.Box 1025 State Road,Stove;MA 01775
APPLICATION FOR PERMIT
.r .
n ,1 Date:
Permit
(City or Town) (If Applicable) Dag Safe Number
In accordance with the provisions of M.G.L. Chapter l 0 as
provided in Section 527 C M R 34 application
ation is hereby made Start Date
by J 6� �/! pp�6�
(Frill name ofperson,Firm.or Corporation)
State clearly Address
purpose for (Street orP.a Box City or Town)
whequestd For ermissionto Locate dumpster for construction/renovation/demolition is requested p of structure
Comments: dumpster must be 25 ' 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. 1
(If Applicable)
Date Issued-rejected
By A,--�
{Date of expiration Fee Signature ofApplicant)
� .Paid Due
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The Commonwealth of Massachusetts
Department of Firs Services
4a
Office f the Firs Marshal
P.0,Box 1025 State Road,Stow,MA 01775
Permit�0 Date:17010 VT A--
(City of Town) (If Applicable) Dig Safe Number
In accordance with the provisions of M.G.Z. Chapter l Oas provided in section 5 2 7 CMR 34
This Permit is granted to: ? � e Start 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: a t end of workday
at
(Give location by street and no,or describe in such manner asp provied adequate identification of location)
Fee Paid$ t j"3
This Permit will expire — (Signature of offical anon
gr g permit) O , granting permit (Title)
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