HomeMy WebLinkAboutDumpster application and permit - Application - 276 ANDOVER STREET 6/21/2017 _-5 The COMMOnweafth 0' Massachusafts
Department of Fire Servuces
Off!cG of the State Fire Marshag
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
0,/ X_ Permit No
Date:
t City or Town,) _ (If_App1�icab1,_) Dig 8afeNumber
In accordance with the provisions of M,G.L. Chapter_0 as
provided in section 527 C M R 34
b S� —_ application is hereby made Start Date
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Fuff name ofpFson,Firm or Corporation
State clearly Address S1, A
purpose for (Street or P.O.Box City or Town)
which pem2it Forpm-nissionto "Locate dumpster for construction/renovation/demolition �,-,is requested of structure
Comments: dumpster must be 251 from structure or covered when not in use
at L
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Name of competent operator Cert.NO,
(Tf Applicable)
Date Issued-x*-eted -ji_
By
Date of expiration L7 Fees ;Si�gPn �8 :p' ant)
?aid
Due
Z The Commonwealth Of Massachusetts
Department of Fire Services
is of the State Fire Marshal
P.0,Box 1025 State Road,Stow;MA 01775
PERM.IT
4,-7 Clic)b-f -t- Permit No Date:
(City of Town) (1f Applicable) Dig:181a9fe 7INIummber
M.
In accordance with the provisions of G.L. Chapter 10 as provided in section 5 2 7 C M R 34
This Permit is granted to: S�2,11 J, f Z� 4<- EftrtDate
Full name of person,Firm or Corporation
Permissionto --locate dumpster for construction/renovation/demolition of structure
Comments' dumpster be 251 from structure or covered with tarp or Plywood
Restrictions: at end of workday
at t-,
(Give location by street and no.,or describe in such manner as t9 provied adequate identification of location)
Fee Paid S
This Permit will expire
01ruaLuz0 01 01110al granting 5�i�t) Offiral granting permit (Title)
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