HomeMy WebLinkAboutDumpster application and permit - Application - 245 WAVERLY ROAD 5/4/2017 The Commanweafth Of- Massachusetts
e D PallmOnt of Fdve Semicss
Office ®f the State Fire Marshal
P-0.Box 1025 State Road Stow,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No
7city or Town) (If Applicable) Dig Safe Mimber
In accordance with the provisions OfM.G.L, Chapter 10
providedin Section 527 �CMR 34
by Z app. anon i ereby�a d2as
tar Date� � , ,
Fu11 mane ofperson,Firm or Corporation)
State clearly Address
Purpose for
which permit (Street or P.O.Box City or rmm)
is requested Forpermissionto Locate dumpster for construction/renovation/demolition
Of structureV�L I U-1
Comments; dumpster must be 25_'
from structure or covered when not in use
at
(Give location by street and no.,or describe' such manner as to provieci adequate identification
of location)
Name Of competent operator
(If Applicable) Cert.No.
Date Issued-rejected By ti
S�-( 4/ �t
Date ofespiration 7? Fee Signature of Applicant)
------- ,Paid
--—---------------------- Due
The Commonwealth Of Massachusetts
Department of Fire Services
Office of the State Fire Marshal
P-C.Box 1025 State Road,Stow,MA 01775
Permit No PERMIT Date:
(City of Town) ---71f A—pplica—ble
In accordance with the pro-visions of M.G.L.
Chapter l Oas Provided in section 5 2 7 CMR 34 Dig Safe Number
This Permit is granted to: Start
A_,e- -----------
Permission to Full-name of Person,Firm Or Corporation
locate dumpster for construction/renovation/demolition Of structure
Comments: dum]Dster be 251 from structure__,or Covered with t
Restrictions: at end of workday tarp or Plywood
at
Give location by street and no.,or des
Fee Paid$ e In such manner as to provi d adequate identification of location J
This Permit ill expire e Of offical granting permit) cal gran' permit
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