HomeMy WebLinkAboutDumpster Application & Permit - Permits - 48 REGENCY PLACE 12/8/2016 The COMManweafth 0 Massachusetts
Department of Fire Services
Office of the State Fire Marshag
P.0,Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
No(City or-Town) ----FTf�Apphcablc) Dig Safe Number
In accordance with the provisions of M.G-L, Chapter . ' 1�0 .as
provided in Section 527 C M R 34 li ' ' - Date
by 11,is hereby made Start
Rill name ofperson,Firm or Corporation) P03 �i
State clearly Address (zl
purpose for (Street o P.O.Box City or Town)
Whichpermit Forpermissionto Locate dumpster for consrtruction/renovation/demolition *,,�,,
is requested Of structure
Comments: dumpster must be 25 ' from structure or covered when not in use
at Rims-TV picc
Give lor -t—
atioAystreet and no,,or describe in such manner as to provied adequate identification Of loca-t—ion)
Name of competent operator
L Cert.No.
(If Applicable)
Date Issued-rejected 11001
By
7
Signature of Applicant)
Fee$ 0
:Paid Date of expiration
-------------- yd --50, Due
--------—---------------------------------
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The Commonwealth of Massachusefts
Department of Fire Services
Office of the State Fire Marshal
P.0,Box 1025 State Road,Stow,MA 01775
Permit NO PERMIT Date:
04 Of Town) ---(If Applicable) Dig:,Slafe 7Numnb—or
In accordance with the provisions of uaL. , Chapter as provided in section 5 2 7 CMR 34
ZZ If , �� - 11 —
A 1-2 EStartDate
This Permit is granted to:
Flull 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 oz ? �--
6-0 street and no.,or des 'be in such nner as o provied adequate identification of cation
Fee Paid$
This Permit wrll expire Of 0 Cal granting permit offical gran permit Title—)
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