HomeMy WebLinkAboutDumpster application and permit - Application - 56 PHILLIPS COURT 4/26/2017 The COMMORweafth ag Massachusafts,
DepaFtment of Fire Semices
Office of the Stator Fire Marshal
A--Er 1161
P.O.Box 10-95 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No
(C-HtTor—Tom) --- (If—Applicable) Dig Safe Nuumber
In accordance with the provisions of M.G.L. Chapter 10 as
provided in section 527 C M R 34 application is hereby made FStaitDate
by 0
J V CZ/1 c /-'Zl ell c-l-e"/1-
(Full name of person,Firm or Corporation)
State clearly Address L"r 7 (7 g,
purpose for (Street or P.O.Box City or To—)
whichpermit Forpermissionto - Locate dumpster for construction/renovation/demolition
is requested of structure
Comments: dumpster must be 25 ' from structure or covered when not inuse
at 1,0 5- C/ '7) V
Give location by street and no.,or d tribe in such manner as to provied adequate identification of location)
Name of competent operator Cert No
(HApplicable)
Date Issued-rejected By
(Sigriature of Applicant)
Date of expiration Fee
Fee Paid Due
—----—------—---—-—-------—---------------------—-cut-------------------------------------- —-----
The Commonwealth of Massachusetts
Department of Fire Services
ice
of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
Permit No PERM.IT Date:
City of Town) --- (1—fA�pphcable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter 10asprovidedin section 527 CMR 34
Date
Start Date
This Permit is granted to:
levx"?- k--'Llet"f -1
.�2 1.�2 !!;;I'Fr
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 /moo f 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 67—
Signature— 4o 9off i c�al granting�permit 0 granting pelt
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