HomeMy WebLinkAboutDumpster application and permit - Application - 141 APPLETON STREET 5/22/2017 Q
The COMMOnweafth C' Ma- saachusafts
Depanment of Fire Sw
Off!CG of the State Fire MarsW
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT Date:
Permit No
City or Town) ----(I—A�pplicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter . 1_0 as
provided in Section 527 CMR 34 a—lication is hereby made Start Date
by
(Full name ofperson,Firm or Corporation)
State clearly Address C—
purpose for (Street or P-0.Box City or Town)
which permit Forpermissionto " Locate dumpster for construction/renovation/demolition
is requested of strud-ture
Comments; du,mpster must be 25 ' from structure or covered when not in use
at
(Give loc'alion by street and no.,or describe in such manner as to provied adequate identification of location)
Name of competent operator CA'0, S-Qv J Cert.No,
(If Applicable)
Date Issued-rejected 2 1-7 By
41
Date o I f expiration I (Signature of AppHoaut Fee Paid /�- Duo
—-----—-------—-—---------—---------------—-cut- --------------—-------—-—--——--—---—----------—-——------—--------—-----
The Commonwealth of Massachusetts
Department of Fire Services
OffiCe of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
PERM.IT
Permit No Date:
City Of To—mi—) (If Applicable) DigSaf:eNujmb—er
In accordance with the provisions of M.G.L. Chapter 10as provided in section 5 2 7 CMR 34
EStaztDato
This Permit is granted to:
Full name of person,Firm or Corporation
Permissionto locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 25 ' from structure or covered with tarp or plywood
Restrictions: at end of workday
at Z V1 1-414a—lr 7--��,, —TI
(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 (Sign e o offical granting permit) Offi a1 granting permit (Title)
TWIG PI=PMIT MI I-qT"RP rr)M-qD1r1 in,ICI Y
Pf)-CZTPn 1 IDMI TWX
