HomeMy WebLinkAboutDumpster Application & Permit - Permits - 217 WINTER STREET 12/27/2016 The COOnweaath of Massachusafts
DOPUt Ont of Fine SeffVICS8
~= Office of the State Fire MarshaQ
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT Date:
�` ® � Permit No
(City or Town) (If Applionble) Dig Safe Number
In accordance with the provisions of M.G.L, Chapter 0 as
provided in S 7ction. _527 C M R 34 ap lication is hereby made start Date
by
(Fi llname ofperson,Finn or Corporation)
State clearly Address
?urpose for (street orP.Q Box pity or Town)
a requested For erxnissionto Locate dumpster for construction/renovation/demolition ';�szequested p of structure
Comments: dumpster must be 2- from structure or covered when not in use
at �� 7-£, ✓
(Give location by street and no,,or describe m' 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 eaPiration Fee$ ,Paid Due
_---___. .__._______-___------------------------�..__------- -cut- -------------------____-_-------- - .._._-___._..____
The Commonwealth of Massachusetts
Department of Firs Services
Office Of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775 it
Permit NO Date:
J-
(city of Town) (I£Applicable) Dig Sa7191u, er
In accordance with the provisions of aL. Chapter 10as provided in section 5 2 7 CMR 34
This Permit is granted to: 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'J workday/ ,
at oC ! �t/ % ®2 sue- rr�
(Give location by street and no,,or describe in such manner as o provied adequate identification of location)
Fee Paid$ -�`
This Permit will expire - r
xP. l (Signature of offical granting permit) 0ffic grantin ��� `'®�r�i�
g permit (Title)
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