HomeMy WebLinkAboutDumpster application and permit - Application - 99 RALEIGH TAVERN LANE 6/27/2017 The COMMOnweafth Of Massachusetts
'14 .
J Da Depanment of Fire Serr-vices
Office of the State Fire Marshao
R 0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
'L Date:
Permit No
City or-rovm ----(If�Applicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter_ 1_0 as
provided in section 527 C M R 34 application is hereby made Start Date
by
Full name of per Firms
Or Corporation)
State clearly Address
purpose for
which parrait "Locate dumpster (Street orp.o.Box city Town)
is requested For permission to for construction/renovation/demolition ',-,.,
of structure
Comments; dump'ster must be 25 ' from structure or covered when not in use
at
location �=dno,o/rdesc,-j�,
(Give location be in such manner as to provied adequate identification of location)
Name of competent operator Cert.No.
(If Applicable)
Date Issued-rejected BY
d Signature of Applioant)
Date of expiration Fee Paid Duo
--- ---------------cut--__ -_-__.__-----------------------Commonwealth of Massachusetts
Department of Fire Services
Office of the to Fire Marshal
P.O.Box 1025 State Road,Stow,MA 01775 it
Permit No PERMIT Date: � --L) /,�
(City of To)mmm (IfApplicable) Dig Safe Number
Date
Start ED
In accordance with the provisions of M.G.L. Chapter 10as provided insection.527 C M R 34 —1
Stait Date
This Permit is granted to.
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: .t e n d o f workday
at C q 51�Z,-
e location by strut andno.,or describe in such manner as to provied adequate identification of location)
Fee Paid$
This Permit will Wire
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