HomeMy WebLinkAboutDumpster application and permit - Application - 90 SPRING HILL ROAD 7/12/2017 The Ca man sa�th Of Massachusetts
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Office of the State F re MarshaQ
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
N .
Date:
(City or Town) Permit No (If Applicable) Dig Safe Dumber
In accordance with the provisions of M.G.L. Chapter 00 as
provided in sections 527 CMR 34 application is hereby made Start Date
by
(Full came of person,Firm or Corporation)
State clearly Address (� �<l l,/t�'(l-/f( , 'Z.D
purpose for (Street or
is requested P.O.Box City or Town)
whicuested p For ermissionto Locate dumpster for construction/renovation/demolition '-,
of structure
Comments: dumpster must be 2.5 ` from structure or covered when not in use
at
(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 f
BY / �—r-Signaturo
of Applicant)
Date of expiration Fee$ .Paid Due
---------- - _-_— _------------- ---- ------------------------ cut------------------- ---------------------. _ ___.___--_.--_._._--
The Commonwealth of Massachusetts
oDepartment of Fire Services
ffiCe of the State Fire Marshal
o~ P.0.Box 1025 State Road,Stave,MA 01775 it
PERMIT 7
Permit No Date:
(City of Town) (1f Applicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter 10as provided in section 5 2 7 CMR 34
This Permit is granted to:
!t l rev AAAtt;lA"� Start Date
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 oa- plywood
Restrictions: at end of workday
at �4 l I t
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid$ ,�'-7) _-- �
This Permit will expire �0-- (Signaturo of6cal anon �pern�t
Sr g parmit) Offi (Title)
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