HomeMy WebLinkAboutDumpster application and permit - Application - 106 SECOND STREET 7/12/2017 The COMM Oanweafth Of Massachusetts
Pepartment of Fire 88�vices
Office of the State Fire Marshau
P.0.Box 1025 Stat-,Road,Stogy,,MA 01775
APPLICATION FOR PERMIT
Permit No Date:
City or Town) (If Applicable Dig Safe Number
In accordance with the provisions of M.G.L. Chapter_ 10 as
provided in section 527 CMR 34
by --application is hereby made Start Date
4 C)e
�Fuff n=��esaj,Firm�or Ekill name ofP A,Firm or Cor or
corpor n
State el early Address X
Purpose for
which permit (Street or P.O.Box C4 or Town)
is-requested Torparmissionto Locate dtmpster for construction/renovation/demolition
Of stru(f t u r e
Comments: dumpster must be 25 ` from structure or covered when not in use
at aQ (,. S'r ;z-.
(Give location by street and no.,or describe in such manner as toprovied adequate identification of location)
Name Of competent operator
(If Applicable) Cert.No,
Date lssued4*tted By
Date of expiration (Signature f Apphc at�) '
gee$ Paid Due
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The COMMOnwealth of Massachusefts
Department of Fire Services
Off'[CG of the State Fire Marshal
P.0.Box 1025 State Road,Stow,Na 01775
PERMIT
Permit No Date:
(City of Town) -- (If Applicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapterl 10as provided in section 5 2 7 CMR 34 EStartDato
This Permit is granted to:
Full name of person,Firm or Corporago/n
POrMissionto -_locate duml)ster for construction/renovation/demolition of structure
Comments: d u m p stem be 2V from structure or covered with tarp or plywood
Restrictions: at end Of workday
at A _CZ �-?-f F
Give location by street and no.,or describe in such manperyas to provie adequate identification of location)
Fee Paid$ If nr
This Pemi it win exie r SI aturA
ral granting permit) flcal granting permit (Title)
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