HomeMy WebLinkAboutDumpster application and permit - Application - 1 PETERS STREET 10/31/2017 The Commonwealth of Massachusefts
�"=_ r Department of Fire Semites
`.N ` Office ®f the State Fare Marsh a
P-0,Boy 1025 State Road,Stow,MA 01775
w
APPLICATION IT
Date:
Permit No ---
(City or Town) (If Applicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter . 10 as
provided ection 5 2 7 C MR 3 4 application is hereby m Start Date
by � ,
(FuR name of person,Firm or Corporation)
State clearly Address
purpose for (Street or P.O.Sox City or Town)
whichpermit er
For missiouto Locate dumpster for construction/renovation/demolition
is requested p of s t r u c't u r e
Comments: dumpster must be 25 ° from structure or covered when not in use
at
(Give location by street and no.,or describe in such manner as to pro-vied ade u identi ca' n location)
Name of competent operator Cert o.
(If Applicable)
Date Issued-rejected
By
(Si e of Applioant)
Date of expiration zo �// Fee$ Paid Due
---------- .__ ___ —_--------------------- --- - ------scut-------------__.-__-.---------._ .___ _ _ .__-- __--_..---..
The Commonwealth of Massachusefts
b Department-
ire Services
Office f the State Fire Marshal
= P.0,Box 1025 State Road,Stow,MA 01775 it
PERMIT
Permit No Date: c —C� -d—/ z
(Czty of Town) (If Applicable) Dig Safe:11�_ber
In accordance viith the provisions of M.G L. Chapter 10as provided in section 5 2 7 CM R 34
EStaitate
This Permit is granted to: ��y �
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 —of workday
at
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid$
This Permit will expire ®- — (Si ature of
permit) �01
gr g permit (Title)
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