HomeMy WebLinkAboutDumpster Application & Permit - Permits - 79 ROCK RD 4/21/2017 The COMManweafth Of Massachusaft
Pepanment of Firre Servkes
Officis of the State Fire Marshag
P.P.0.-Box 10295 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No
City or Town)
In accordance with the provisions of M.G.L. Chapter If App lic able Dig Safe Number
provided in Section 527 CMR 34 1_0 as
_application is hereby made start Date
(Full name of person,Firm or Corporation)
State clearly Address 17�
purpose for d:3
Whicbpeimit (Street orp.o.Box City or Town)
is requested For perrnission to Locate dumpster for construction/renovation/demolition ,-,,
0 f s t r—u—d—Eu r—e
Comments: dumpster must be—IS7 from structure or covered when not in use
at Cc_
(Give,location by street and no,,or describe,in such manner as to Provi�edadequate identification—of location)
Name,of competent operator Cert.No.
(If Applicable)
Date Issued-rejected
By
Date of expiration. Signature of Applicant)
Fee Paid Due
—-----—-------—-—----------------——-—-------cut-------
The Commonwealth of Massachusefts
Depailment of Fire Services
Office Oft State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
Permit No PERM.IT Date:
Town) ----(If A�pphcable) Dig Safe Nu—mber
In accordance with the provisions of M.G.L. Chapter�--LOas provided in section 5 2 7 CMR 34 Start Date
This Permit is granted to:
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-1.w I ith t-arp or plywood
Restrictions: a t end of workday
at -- 2Z 0 7
(Give location by street and no.,or describe in such manner as to pro-vied adequate identification of location)
Fee Paid$ 9 : "
This Permit will.expire Signature 0 granting permit)
ling permit Title
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