HomeMy WebLinkAboutDumpster Application & Permit - Permits - 9 BEACON HILL BOULEVARD 1/31/2017 g The COMMOnvVea th of Massachusetts
Department ®f FRVG services
OffiCe ®f the State FIF9 MarghW
Y R 0.Box 1025 State Road,Stow,MA 01775 -~ ..
APPLICATION FOR PERMIT
Date:
c de vgjL Permit No
City or Town) (If Applicable) Dig,Safe Number
In accordance with the provisions of M.G.L. Chapter 10 as
provided in Section _527 C M R 34 application i hereby made start Date
by (fro 5,S 1-0 g cog Art 7r, ¢;n
(FUR name of person,Firm or Co oration)
'tate clearly Address P C uh
urpose for (9traet orP.a Box City or Tawa)
'kuehpezmxt For mToissionto Locate dumpster for construction/renovation/demolition '`�
i requested P of s t r u c t r e
Comments: dumpster must be 25 ' from structure or covered when not in use
at CSC on 1 a c!
�
(Give location by street and no,,or describe in such anner as to pro-vied adequate identification of location)
Name of competent operator Celt.No.
(If Applicable)
Date Issued r ' /— / .7 By
(Signature of Applicant) '
Date of expiration---'-- �l� Fee$ Due
cut------------------— _Paid---- r- -_— ...... .......
The Commonwealth of Massachusetts
Department of Fire Services
Office of the Statte Fire Marshal
el
P.Q.Box 1025 State Road,Stag,MA 01775 it
PERMIT
e permit No Date: . 1 - 9�/7
(City of Town) (If Applicable) Dag Safe Pdumbar
In accordance with the provisions of M.G.L. Chapter 10as provided in section 5 2 7 CM R 34
This Permit is granted to: 6 6 Start 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
Reatrictions: at end o f workday - -
at - ai�l //1
(Give location by street and no.,or describe in such manner to provied ad quate identification of location)
Fee Paid S 6S�
c
This Permit will expire J —1 (Signature of offical granting permit) Offical granting permit ® � (Title
THIR DF=P UiIT MI l_ `I"" F f`-nMIq[alf'_I InI I.ql V f)-QTPn 1113e)M TW;z pI✓'llill_Cp:q