HomeMy WebLinkAboutDumpster application and permit - Application - 15 STACY DRIVE 5/26/2017 The COMM oonweafth 0" Massachusett-a
2 —
DOPartment of Fire Semites
Office of the State Fire MarsW
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No
ity' or'fovm) ---(If�Applicable) Dig Safe Ntursber
In accordance with the pro-visions of M.G.L. Chapter 1_0 as
provided in Section 527 CMR 34 application is hereby made Start Date
by /�)/Z� �/ U/ I I
(Full name of person,Firm or Corporation)
State clearly Address 0
purpose for f4
whiclipermit (Street or P.O.Box City or Town)
is requested Forpern:dssionto Locate dumpster- for construction/renovation/demolition
Of structure
Comment : dumpster must be 25 ' from structure or covered when not in use
at f-T- 15)
(Give location by street and no.,or describe in such manneras to`provied—ad—equ—ate identification of lo—cation)
Name of competent operator Cert.NO.
(If Applicable)
Date Issued-rejected By 2
Date of expiration (Signature".rApplicant)
'
Fee Paid Due
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The Commonwealth of Massachusetts
Department of Fire Services
Off'ICGof the State Fire Marshal
P.0,Box 1025 State Road,Stow,MA 01775 it
PERM t
.I D
T ae:
Permit�I®
—LL� //—�
City of Town) ---TIf�Applicable) Dig Safe—N=mber
In accordance with provi the ,sl. or fm Chapter� 10as provided insecdoa527 CMR 34
1 o
This Permit is granted to: Start Date
Full name of person,Firm or Corporation
Permission to locate dumpster for of structure
Comments: dumpster be 25 ' from structure or covered with tarp or plywood
Restrictions: at end of workday
at
(Give location by street aifdno.,or describe in such manner as;toprOvied a quate identification of location)
Fee Paid$
This Permit will expire
offical gran offic C
Fgrmiting—permit (Title)
TWIR PI=P�MIT MI I-CZT RIZ OnM-RoIrl Inj I_ql V PO-qTPn I mr)Kj TW;z ppj=UI_qj=_q 4mim