HomeMy WebLinkAboutDumpster Application & Permit - Permits - 6 ALLEN STREET 12/29/2016 The CO MOnweafth Of Massachusetts
DOPaFtMOnt of Furze Sgnftea
t _ Office Of the State Fire Marzhau
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W P.G.Box 10225 State Road,Stow,MA 01775 �f A
APPLICATION FOR PERMIT
Date:
Permit No
City or Town)
(ffApplicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter 10 as
provided in Section 527 CMR 34 application is hereby made Start Date
by �n
(Fun name ofperson,Firm or Corporation) .
'Mate clearly Address 01 P -;71\I-k An c�c-' t'�'L ✓' ' U i a z--)t
urpose for (Street or p a Box City or Town.)
7hichpeimzt e For m2issionto Locate dumpster for construction/renovation/demolition irequested p of struct re
Comments. dumpster must be 25 ' from structure or covered when not in use
at t1.�:7/", r�l1 A'- c c - 'L t , 11A_r -
(Give location by street and no,,or describe in such manner as to pro-vied adequate identification o£location)
Name of competent operator L y�,� Cert.No.
(If Applicable)
Date Issued-rejected By
(Signature of Applicant)
pate of expiration Fee$ -Paid Due
,—- -----_---
The Commonwealth of Massachusetts
' Department Of Firs Services
a`
Office of the Stale Fire Marshal
P.O,Box 1025 State Road,Stow,MA 01775
PERMIT
Permit No Date:
(City of Town) (If Applicable} LNgSafeNumber
In accordance with the provisions of M.G.L. Chapter1 Oas provided in section 5 2 7 CMR 34
This Pernut is granted to: �£ �� StartD
�����
Full name of person,F o oration
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 '�/Z'
(Give location by street and no.,or describe in such manner as o provied adequate identification of location)
Fee Paid S
This Permit will expire �? - -/ (Signature o offical anizn "t c
g permit) Off c granting permit (Title)
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