HomeMy WebLinkAboutDumpster Application & Permit - Permits - 351 WILLOW STREET 1/10/2017 The Commonweafth of Massachusetts
a try. W aOffice ®f the State Fire MaraW
` P.0,Box 1025 State Road,Stow,MA 01775
a APPLICATION FOR PERMIT
.:.,, Date:
c y" �4 C` E ermit No Dig Safe Number(City or Town) (If Applicable)
In accordance with the provisions ofM.G.L. Chapter 10 as �9 c C-x
provided in Section 527 CMR 34 _application is hereby made Start Date
by c.M cn= V)&`, 1 C iL �3 ► L
(Full name of person,Firm or Corporation)
tate clearly Address L, T)0-�\J F C�u !W G' �
urpose for (street orP.a Box City orTc )
rbichpermit Forpemrissionto Locate dumpster for construction/renovation/demolition
'�o
itequested of strudture
Comments: dumpster must be 25 ` from structure. or covered when not in use
(Give location by street and no,,or describe in such manner as to provied adequate identification of location)
Narue of competent operator Cert.No.
(If Applicable)
Date Issued rejected By
(Signature of Applicant)
Bate of expiration cal' Fee$ �5C..C—l�`, :Paid 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 Date:
t,�—O C)`iT ER i fN)+—A Permit No Dig Safe Plumber
(City of Town) (If Applicable) tt Q'C1
In accordance with the provisions of M.G.L. Chapter 10as provided in section 5 2 7 CMR 34 Sit Date
This Permit is granted to: C'i`1� ►�:v i& ) G 1-) 1 L!
Full name of person,Firm or Corporation
Petmissionto locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 25 ' from structure or covered with tarp or plywood
Restrictions: 'at end o f workday
at `?��) s LC W) 1�3 TQ'E'ET--SOu i K"0C�\V-Q 5��1 . C�, �S
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid$ Gj CS, 12
4 -,'r� 9�f-�
This Permit will expire 2' (Signature an�ing permit) 0 .cal sting permit (Tide)
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