HomeMy WebLinkAboutDumpster Application & Permit - Permits - 149 BERRY STREET 2/17/2017 The COMMOnweafth of Mazaachusafts
Department of Five Services
8
Office of the State Fire Marqhal
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
Permit N® (If Applicable) Dig Safe Number
(City r Town)
In accordance with the provisions of M.G.L, Chapter 10 as
provided in section 527 C M R 34 application is hereby made Start Date
by ,7 515 Z2 4 S& 5'-5 —
(Full name of'person,Firm or Cotporation)
State clearly Address
purpose for
whichpennit (Steetorl?.O.Box CiWorTown)
is requested ForpmTnissionto Locate dumpster for construction/renovation/demolition
of structure
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 ------11
Signature of
.ant)
Date of expiration Fee P
Due
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Z The Commonwealth of Massachusetts
Department of Fire Services
Office of the to Fire Marshal
R O.Box 1025 State Road,Stow,MA 01775
PERM,IT
Permit No Date: Z 7
City O�f,_Town) ____(If�Applicable) DD:igSs9:feN:umbe7r _
ate
In accordance with the provisions of M.G.L. Chapter 10as provided ia section 527 CMR 34
This Permit is granted to: Start Date
Full name of person,Firm or Corporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: d u m p s t e r be 25 ' from structure or covered with tarp or plywood
Restrictions: at end o f workday
at
�be in �anneras�t
(Give location by street an no.,or In 0 pro-vied�adequate�identification of�location
Fee Paid$
This Permit will expire (Signature of offl, granting permit) Offical gran orrait
(Title)
THIR PP;?UIT MI I_QT`R1= rnMRDiri inj I-ql V PORTPn I 10r)M TW;z PPPU1_Q;=_q -*MW