HomeMy WebLinkAboutDumpster Application & Permit - Permits - 3/9/2017 The Cammonjiviea th
Qeputment of Firre Se - ices
Office of the State Fire Marshag
R 0.13ox 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT Date:
0 Permit No
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or Tovm)
If Applicable) Dig Safe Number
In accordance with the pro-visions of M.G.L. Chapter�- 1_0 as
provided in section 527 CMR 34
by rN application is hereby made StartDate
Le A 5-
Address (Full name of person,Firm or Corporation)
State,clearly
purpose for (Street orP.0.Box City or Town)
whiclipermit Forpermissionto ' Locate dumpster for construction/
is requested of st renovation/demolition ,-,,,
Comments: dumpster must be 25 ' from structure or covered--when--not in use
Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Name,of competent operator Cert.N
(HApplicable)
Date Issued-xqk.Gtaj- 9 -,-7 By
Date of expiration /7 (SipatureofApplicant)
Fee
--— —-- ---------- Paid Due
—-------—-cut-------------.__---------------------------
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Commonwealth of Massachusefts
Department of Fire Services
Office of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
V, Permit No PERMIT Date:
(City of Town) ----(If Applicable) :Dig1S1aLf:eN:uim�b—e7r
In accordance with the provisions of M.G.Z. Chapter 1 Oasprovidedin section 5 2 7 CMR 34
This Permit is granted to: a, 112 F 1--_7 - 1 ::7 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 plywood
Restrictions: or
at end Of workday
at
Fee Paid (Give location by street and no.,or describe in such manner as to provied adequate identification of location)
This Permit will expire el granting ae40r*Mtin—gpeMit
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