HomeMy WebLinkAboutDumpster Application & Permit - Permits - 497 WOOD LANE 1/24/2017 The CO MOnwea8th (of Massachusetts
�CF ,'4►_ Department off F re ser Aces
r;L I Office ®ft U.8 SISRitIr FILllit
P.0.Box 1025 State Road,Stow,MA 01775 �� ..
APPLICATION PERMIT
>o Date:
permit No
T—c7lty or Town) (If Ap lioable P ) Dig safe l�tumber
In accordance with the provisions of M.G.L. Chapter , 1 0 as
provided in Section 527 CMR 34 application is hereby made [S;tartD:ate
by ,�- ` --
(l ull name of person,Firm or Corporation)) I �?
ate clearly Address ® 1 f
1 1 ®
Tj7o58 for�chper (street orP.O.Box City orTowa)
cequested For ermissionto Locate dumpster for constructionn/renovation/demolition 'Lo requested P of strudt re
Commems: dumpster must be 251 from structure or covered when not in use
at Q
(Give location by street and no,,or describe is such manner as to provied adequate idantiizeation o£location)
N=0 of Competent operator Cert.No.
(If Applicable)
Date Issued rejecte By
( 'gnatureofApplicant)
_ Date of expiration , Fee$ , Due
_.camDepartment of
The Commonwealth of Massachusetts
_ N
Fire Services
Officead the State FIreMarshal
P.4,Box 1025 State Road,Stow,MA 01775
PERMIT
Permit No y/7
Date:
(City of Town) (If Applicable) Dig Safe-Numb I er
In accordance with the provisions of M.G.L. Chapter 1 Oas provided in-sectioa 5 2 7 CMR 34
This Permit is granted to: e Start Date
Full name of person,Firm or Corporation
Pemussionto locate dumpster for construction/renovation/demolition of structure
anvnents: dumpster be 25 ' from structure or covered with tarp or plywood
testriotions: a t end Of workday
it
(cTive location bystreet and no.,or describe in such mnanner as to provied adequate identification of location)
tee Paid S
;his Permitwill expire o� (Signature of offical grantingpermit Qc�grantingp`ermit (Title)
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