HomeMy WebLinkAboutDumpster Application & Permit - Permits - 161 MAIN STREET 12/13/2016 The co m
,n M a
DRPaftment of Hos I
Office of th's statG
Fire Marshau
P.0'B(';;1121 Itate Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
er
City or Town M10
In accordance with the provisions ofM.G.L, Cbapter ._HA�ppjicable) � Deg Safe Dumber
provided in Section CM, 34 — 10 as
by --aPPlication is hereby made
Start Date
(FUff name aperson.Firm or corporation)
State clearly Address ,,("_,, , I_—
Purpose for
IL
BOX Cit OrTovm)
which permit
091reat
Forpermissio.uto Locate L _ �� Ir 0�B. -C
is requested Of structuredump st er for conor
Comments; d u ' - stTuction/renovation/demolition
mpster must be 25 ' from structure or
at covered when not in use
cation by street and no.,or describe is such manner as to Provied,adequate identification of 100,1tion)
Name Of competent operator '
(YApplicable) Cert.
Date Issued-rejected , 1',-7 No.
By z
jPn1t1r1 fApph.�. i
Date of expiration
Fee (�Patura ofAppHcant)
,Paid Co Dw
The
uOmmonwealth of Massachusefts
Department Of Fire Services
0ff1cG Of the State Fire Marshal
P.0,Box 1025 State Road,Stow;MA 01775
PERMIT
�(City Of Toe)�Cz Permit No Date:
_ 71f—App—li—c In accordance with the provisions of M.G.L. a—blo—) Dig Safe Number
This permit is granted to: & �*t" I Oas Provided iase&on 5 2�7CMR 34
6,1 Start Date
name
Full aU name of Person,Firm or Corporation
Permission to locate duMpster for cOn,9tructi
,omments: on renovation/demolition Of structure
dUM'Dster be 25 ' from structure or covered
testrictions: at end Of workday )r plywood
t
"011 1111
"0.1111-
Give location bystrwt and no,,or describe in such manner
0. 00 en cati of I cation
ae Paid$ as to proviod adequate id t,fi a
his permit will expire
e of offical grantingpermit) Offical anting permit
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