HomeMy WebLinkAboutDumpster application and permit - Application - 57 CANDLESTICK ROAD 8/10/2017 -�_ The C® mom earth of Mazaachuggtts
. �t Department oil Fire Services
ace of the State Fare Marshag
0
P.0.Box 1025 State Road,Stow,MA 01775 APPLICATION FOR PERMIT
Date:
(City or Town) Permit No ,
(If Applicable) Dig Safe Number
In accordance with the provisions of U G.L. Chapter 00 as
provided' ection 527 C MR 34 application is hereby made Start Date
by --
(Full name of person,Firm or Corporation)
ClAe-
State clearly Address Z— I
purpose for i(Street or
is requested pmissionto P.O.Box City or Town)
whichpermit For er Locate dumpster for construction/renovation/demolition
Of structure
Comments: dumpster must be 25 ' from structure or covered when not in use
at ���� 96-1
-
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Name of competent operator Cert•No.
(If Applicable)
Date Issued-rejected By
(Signature of AppHoant) ,
Date of expirations�`�Zj' Fee$ Paid Due
_---___. _-------- -------._—--- -----_------_--_ __---- -cut---------------------------------- —— - __ _ -__ ----------
Department The Commonwealth of Massachusetts
f Fire Services `
Office of the State Firs Marshal
R`0~ P.0,Box 1025 State Road,Stow,MA 01775
PERM.IT
Permit N0
Date: .,
(City of Town) (If Applicable) Dig Safe Pdugnber
in accordance with the provisions of MG.L. Chapter 10as provided in section 5 2 7 CMR 34
This Permit is granted to: %P 2
Start Date
Ir
o j
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: at end of workday
at
(Give location by street and no.,or describe in such manner as to Pr vied adequate identification of location)
Fee Paid S �g�— /
This Permit gill a )
XP� !S� (Signature of o cal granting permit Offical
gt g permit (Title)
TWIA PPPMIT MI I-QT,RP t`- Kj-gpjrj IC I t_�I Y Pn-q'rPr1 I InCIbt TWI= PPPmj-qp_q