HomeMy WebLinkAboutDumpster Application & Permit - Permits - 51 DAVIS STREET 4/10/2017 The COMM00 nweafth Of
Qepautment of Fire Services
I 4A6
Office of the State Fire MarsW
P.C.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT Date:
Permit No
city or Town (IfApplicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter_ 1_0 as
provided in section 527 CMR 34 app.catio is hereby made Start Date
by 0e) (Full name of person,Firm-o Corpo on)
State clearly Address /'! Z)
?Urpose for
Pkicbpermit (Street 051".0.Box Cif or Town)��
s requested Forpermissionto Locate dumpster -for cOnstruction/renovation/demolition ,.,,
Of structure
Comments: dumpster must be 25 ' from structure or covered when not in use
at -A
— (,Give location by start and no.,or describe in such manner as to provied adequate identification of location)
Name of competent operator
(If Applicable) Cert.No,
Date Issued
-r4jeeted" By
Date of expiration (SignatureofAp cant)
Fee Due
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The Commonwealth of Massachusetts
Department of Fire Services
Office of the to Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775 it
Permit No PERMIT Date: -,-,7
(City of Town) (If Applicable) Dig Safe Number
In accordance with the provisions of M.G.Z. Chapterl 10as provided in section 5 2 7 C M R 34
This Permit is granted to: C/1 Start Date
Full name of person,Firm or Corporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 95 ' from structure 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)
Fee Paid S
This Permit will expire granting permit Offical graMng permit Title
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