HomeMy WebLinkAboutDumpster application and permit - Application - 48 HAROLD STREET 6/28/2017 The CO MOnweafth C' assachusa -
4 Depatment of Fare SSerr-vices
Office of the State Fire Marshao
YpV
"c P.0.Box 1025 State Road,Stow,MA 01775
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
providerozAt'--p
' Section 527 C M R 34 application is hereby made start Date
by n QLL1T r T�nN
(Full name ofperson,Fain or Corporation)
State clearly Address Z t IF A R�
Purpose for ��TN � �'� VV��tcG S /F
which permit (Street orP.O.Sox City or Town)
For ermissioato Locate dumpster for construction/renovation/demolition �
is requested p o f s t r u c't u Fe
Comments: dumpster must be 25 ' from structure or covered when not in use
at el .?5 4-1 A- R O L 6 S T
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Name of competent operator Cert.Na.
(If Applicable)
Date Issued rejected By
(Signature of Applicant)
Date of expiration Fee$ Paid ,Due
---------- --_-------------------------------------------_-------------cut------......._._.___--___---_—__,--___--_ - __._�------------____--__-----
The
Commonwealth of Massachusefts
Department of Firs Services
-S
Office of the State Fire Marshal
fie~ P.0.Box 1025 State Road,Story,MA 01775
. ` !/ Permit N0 PERMIT Date:
(//City of Town) (If Applicable) Dig Safe Namber
In accordance with the provisions of M.G.L. Chapter 10as provided' section 5 2 7 C M R 34
This Permit is granted to: Start Date
f � `� lip�L!'f//J/�
Full name of person,Firm or Corporation
Pemzissionto 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 provi d adequate identification of location)
Fee Paid$ `� _ f
This Permit will expire &/` .— (Si�ature of��c�l �gpa2) Offical gran' permit
expire
Title)
TWIR PPRMIT MI I_QT"RP tanM-q 1r1 Inn 1_CIV Pn-q`f'Pn 1 I0r5M 7"I-89 P;7 ICE