HomeMy WebLinkAboutDumpster Application & Permit - Permits - 440 GREAT POND ROAD 2/1/2017 The, Cammanw
eakh
Of Massachusefts
DePaFtMOnt of F�[re 39pV&Cea
Off!C6 Of the State Fire Marshag
P.0,-Box 1025 State Road,Stow,mA 01775
APPLICATION FOR PERMIT
Permit No Date:
City or
(If Applicable)
In accordance with the provisions of M.G.L. Chapter _,__ 10 as Dig Safe Number
provided in Section 527 C M R 3-14
— - application is hereby by made Start Date
-'Zz�-c 47 -L142
Fall name ofperson,Firm or Corporation)
Mate clearly Address
urpose for
ihich pamlit (StreetorP.aBox cityorTov.)
t requested Forpennissionto Locate dumPstGr for c()nstructj
of On/renovation/demolition
Comments: dump-ster must be 25 - from structure or covered
at
e location by street and no.,
or describoiu such manner as to provied adequate identification of location)
Name of competent operator
(IfApphcable) Cert.No.
Date Issued rejected
By
Date of expiration (Signature dAppliraut)
Fee Paid Due
The Commonwealth Of Massachusetts
Department Of Fire services
Office of the State Fire Marshal
R 0,Box 1025 State Road,StGvv;MA 01775
PERMIT
City of Town) Piz ffi% NO Date,
In accordance with the provisions of m.aL. ---T1—fAPPhoable—) Dig Safe Number
-2FVThis Permit is granted to: Chapter l—I Oas Provided ia-sectioa 5 2 7 CMR 34 L
zae StartDatf; -74Z/2
Full-name Of'Person,Firm or Corporation
?ennission to locate dumnmte,r for construction/renovation/demolition Of structure
I
,omments: dum'Dster be 251 from structure
"'�'�Ilr 10�u workday
z�Dz covered with tarp or nlvwnn
rkdav��.�Le�®r �Cove�re
'estrictions: at end d o f -k d-
Give location by street and no,or describe in such manner as to pro od adequate identification of location.)
�Paid S
its Permit will expire (—Signature of offiJoal
cai granting permit Title
TH 1A PPPiltlIT Fin I I-qT"R P: rr'm-,Rl3u-n ini vqiVP0-QT1=n I 1p()M TW;z