HomeMy WebLinkAboutDumpster application and permit - Application - 70 MAY STREET 7/26/2017 The Commonweafth of mazaachusgtij
Department of Fgre Se�Aceq
Off!C8 Of the Simte Fire Marqha�
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
(City or Town) Permit No ---(-1f Applicable) Dig Safe Number
In accordance with the provisions of MG.L. Chapter 10 as
provided in section 527 C M R 34 application is hereby made Start Date
by r
L,/-(U
(Full name ofperson,Firili or Corporation) k-4 5
State clearly Address purpose for (Street or P.D.Box City or—T-wn)
which permit Forpertnissionto "Locate dumpster for construction/renovation/demolition ,
is requested Of structure
Comments; dumpster must 1—e -25—' from structure--or—covered when notin use
at -70 [-1()--\, �-f A P,-- * -LL, A�CJCJ L-0 � N W
(Give locate by street and no,,or describe in such manner as to provied adequate identification of location)
Name of competent operator IL"14 1 CA2 Cert.No,
(TfApplicable)
Date Issued-rejected By
ignature,of Applicant
Date of exTiration
Aogla,6, e, Fee Paid 00 Due
--------------------------------cut------------_Commonwealth of Massachusetts
Department of Fire Services
Office of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775 Ar.
Permit No PERMJT Date:
(City of Town) ---FIf�Applicable) Dig Safe Nu—mber
In accordance with the provisions of M.G.L. Chapter_ I Oas provided in section 5 2 7 CMR 3 4
Date
Start Dig
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 291 from structure or covered with tarp or plywood
Restrictions: at end of workday
at
Give location by street and no.,or desc * e in such ma to provied adequat ' entiffic 'on of location)
Fee Paid This Perini 00
will expire Signature of of6cal grantingpermit ffical granting permit (�Titie)
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