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HomeMy WebLinkAboutDumpster Application & Permit - Permits - 1/17/2017 The COMMO eafth 0a Massachusetts Office of the state bare Mar--shag r A P.0.Box 1025 State Road,Stow,MA 01775 �p 4 APPLICATION FOR PERMIT Date: Permit N® City or Town) (If Applicable} =Date In accordance with the provisions of M.G.L. Chapter 10 as provided.in section 527 C M R 34 appgcationiis hereby made y ✓ r ( kiln ofperson,Firm or Corporation) fate clearly Address I✓.; urpase for �. C per it otreetorP0.Box City or Town) xequested Forperrnissionto Locate dumpster for construction/renovation/demolition 'L` of struct+ re Comments: dumpster must be 25 ' from structure or covered when not in use at (Give location by street and no,,or describe in such manner as to provied adequate identification of location) Name of competent operator Cert.No. (If Applicable) Date Issued-rejected By (Signature cf Applicant) Date of expirationj - Fee$ aid Due .__.__..-cut ------------------ The Commonwealth of Massachusetts ark ent of Fire Services OffiCG of the State Fire Marshal P.0,Box 1025 State Road,Stow,MA 01775 Permit No Date: (City of Town) (If Applicable) Ligafe Nusmb_er In accordance with the provisions of M.01. Chapter 10as provided in-section 5 2 7 C MR 34 This Permit is granted to: ®� /��� Shut U 6_ v�1D 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: at end o f w o r k d ay at ©U !'S o��/ (Give location by street and no.,or describe in such manne as t rroovied adequ to identification of location) Fee Paid$ S� r" (z),This Permit will expire (Signature of ofcal granting permit) Offical granting permit (Title)