HomeMy WebLinkAboutDumpster Application & Permit - - 100 COVENTRY LN 4/20/2017 The Cammonweaath as., Mazaachuage
Department of Hire Ser v ceq
S!,
OfflcG ®f the S-ate Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
(C—ItTor Town)
Perinit N® ----Clf�Applicable) Dig S Nu
mber
umber
—
In accordance with the provisions of M.G.L, Chapter 1_0 as
provided in Sectio 527 CMR a lication is hereby made Start Date
by . j L.— -r— -T
Full name of person,Firm or Corporation)
State clearly Address
purpose for (Street orP.O.Box City or Town)
which permit Forpormissionto Locate dumpster for construction/renovation/demolition
is-requested of st
Comments: dumpster must be 25 ' from structure or covered
at its jJ A
(Give location by street and no.,or describe in such manner astoprovied adequate identification of location)
Name of competent operator Cert.No.
(If Applicable)
Date Issued-rejected. By
Sign eof Applicant)
Date of expiration Fee Paid Due
——----- —-----—-----------—----------cut-----------—--—--—---
The Commonwealth of Massachusefts
Department of Fire Services
Office of the Staie Fire Marshal
P.0,Box 1025 State Road,Stow,MA 01775
PERM.IT
le-',V f- Permit lei®
Date:
(—City Of Town) ---7If�Applicable) Dig Safe Nwnbor
In accordance with the provisions of M.G.L. Chapter 10as provided in section 527 CMR 34
Date
This Permit is granted to: 'fV f 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 or plywood
Restrictions: at end 0 f workday
at
L(Give location by street and il() describe in such manner as to pro-vied adequate identification of location)
Fee Paid
This Permit va expire Signai��e�00 cal cal granting�p=)
(Title)
THIA PP�MIT MI I-QT"Falz 1--rWRDIrl InI ICI V Pf)-qTPn I 1pr)M TWjz pp;zKfi,_qp:_q 4ff9M