HomeMy WebLinkAboutDumpster Application & Permit - Permits - 4/6/2017 -� The Comm oanvvea
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{-- � DeParicment of Haire Ser Acea
Otte of the State G it G Marshal
P.0.Box 1025 State Road,Stow,MA 01775
APPUCATION FOR PERMIT
Date:
Permit No -----
(City or Tom)
(Tf Applicable) Dig Safe laiinnber
In accordance with the provisions of M.G.L. Chapter 00 as
provided in Section 527 C MR 34 application is hereby made Start Date
by STg Ctc�1C Comet s-r2u�
(Fullname ofperson,Firm or Corporation)
State clearly Address 3 14 14—,`1
purpose fGr (Street orP_O.Box City or Town)
Ism questech d For mnissimto Locate dumpster for construction/renovation/demolition Is requested p o f s t r u—Ft u r e
Comments: odumpster must be 25 ' . Jfrom structure or covered when not in use
at _ iR t'14SS �}✓� A4aa-rt+ A,tooycn rVl�
(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 4r J—� r _
ignature of Applicant)
Date of expiration Fee$ Paid Due
_------ ------------------------------------------------------------ -cut------------------- � ---------— -----------
The Commonwealth Of Massachusetts
Department of Fire Services
fi e Of the State Firs Marshal
P.O.Box 1025 State Road,Stour,MA 01775 it
1�171 �(/� Date:
�____. Permit fit® ,
(City of Town) (If Applicable) =Date
er
In accordance with the provisions of M.G.L. Chapter 10as provided in section 5 2 7 CMR 34
This Permit is anted to: /�' —
Full name of person,Firm or Corporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dum ster be 25 ' from structure or covered with tarp or plywood
Restrictions: at end of workday
at / %�L S/ —T A ��
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid$
This Permit will expire JJ� Signatiue o cl granting permit
Offical ermit (�T it�le)gp
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