HomeMy WebLinkAboutDumpster Application & Permit - Permits - 212 HAY MEADOW ROAD 2/8/2017 The COMMOnweafth Of Massachusefts
DepaFtment of Firfe SeIrVIC99
Office of the State Fire Marshao
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Data:
LJ'9 D V1?'Ir"l— Permit No
(city or Town) ---TIf�Applicablo) Dig Safe Number
In accordance with the provisions of M.G.L. Cbzpter�_ . 1_0 as
provided in section, 527 CMR 34 application is hereby made Start Date
by
'Full name of person,Firm or Corporation)
State clearly Address
Purpose for (Street opp.a Box City or Town)
mhichpertnit Forpexmissionto Locate dumpster for construction/renovation/demolition
s requested of structure
Comments: dumpster must be-11�' f from structure�or covered wh=n�oti�nuse
at
V 0 vA) ' P-Q
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Name of Competent operator Cart NO.
(If Applicable)
Date Issued-rejected
By n� �n I 1 ��
(Signature of Applicant)
Date of ea matron Fee Paid Due
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The Commonwealth of Massachusetts
Department of Fire Services
Office of the State Fire Marshal
P.0,Box 1025 State Road,Stow,MA 01775
Permit No PERMIT Date: c;2 -T
City-of Town) (If Applicable) Dig Safe:Xum7bFe—r �
In accordance with the provisions of M CT L Chapter sec
� 10asprovidedintioa527 CMR 34
This Permit is granted to: (-2 Start Date
Full name of person,Firm or Corporation
Permission to locate dumpster for construction/renovation/dem6lition of structure
Comments: dumpster be 25 ' from structure or covered with tarp or P1YWUUd
Restrictions. at end 0± workday
at V 1'�Ilf
(Give location street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid S
(Sigt! I r1::;1:1:11
This Permit will expire
rmit
armit (Title
THI-q PPRMIT MI I-qT"R1= r-r-iK1-qJ31p1 inj pqj V PORTM) 1 WrW TW;: PIPU1-q;:-q *NMI