HomeMy WebLinkAboutDumpster Application & Permit - Permits - 1 GREENE STREET 3/9/2017 The Cammonjfveaflth of
DsPartment of Rre Servkeq
Offics of the Smote Fire Marrshag
M
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No
(CityTr—Town ———(MA�pphcabl--) Dig S,-,qfe Num—niber
In accordance with the provisions of M.G.L. Chapter_ 1_0 as
provided i,se,,tio, 527 C M R 34
WE.anon is hereby made Start Date
by 7112 0 0 C�uf' o,
Full name of person,
lum or Corporation)
State clearly Address
purpose for
whiclipermit (Street or P-0.Box City or Town)
is requested Forpermission-to Locate dumpster for construction/renovation/demolition
of structure -
Comments: dumpster must be 25 covere when not in use
at
T
(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
Signature of Applicant)
Date of expiration
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 PERM.IT Date:
(City of Town ----(—If Applicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter 10as provided in section 5 2 7 CMR 34
This Permit is granted to: 1- Start Date
0 zf,/." a 7��
Full name of person, or Corporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 251 from.. structure or covered with tarp or plywood
Restrictions: at end of workday
at
Give location by sireet and no.,or describe in such-manner
cation of location)
Fee Paid
This Permit will expire
(Signature of ollical granting �nmt J �5fftcal'grmtingpermit
(Title)
TWIR PPP.MIT MI I-qT'RP (°r)KI_qpIrl in,I_ql V Pn-QT9=n I IPIW TWR