HomeMy WebLinkAboutDumpster Application & Permit - Permits - 63 MIFFLIN DRIVE 3/7/2017 The COMM oanvveafth DgMazaachussehe
DsPaftment of Rre Serylces
Offics Of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
(C—itTor—Town) Permit No --- (I—f Applicable) Dig Safe Number
In accordance with the provisions of UG.L. Chapter�10 as
provided in section 527 CMR 34
by
application is hereby made Start Date
P
Address Fil name of'person,Firm or Corporation)
ess
State clearly A— "A I
purpose for (Street or P.O.Box City or Town)
whiclipermit For permission to ' Locate dumpster for
s requested of st cOnstruction/renovation/demolition --,
Comments: dumpster must be 25 ' from structure or covered whennot in use
use
at
7-
(Give location by street and no,,or describe M such manner as to to p�rovied adequate identification of Jo--ati()
Name of competent operator
(If Applicable) Cert.No,
Date Issued-rejected
By
(Sig
Date of expiration Fee Paid fA Due ant
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F The Commonwealth of Massachusefts
Department Firs Services
Office of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
Permit No PERMU Date: sT
(Ultyot"Town) :r(If Applicable) Dig Safe Number
In accordance with the provisions of M.CTL Chapter�—1 Oas provided in section 5 2 7 CM 34
This Permit is granted to: /r Start Dig
Full name of person,Firm or Corporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 25 ' from striirtii-r. or covered with tarp or plywood
Restrictions: �
at end Of workday
at
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Fez Paid$
z
This Permit will expire
granting permit) NOT granting permit 2!2e�(TiTle�) -�
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