HomeMy WebLinkAboutBLDTR-19-001489 l 11-1:-"14;11:54AM; ,VVoccuvVQV •. .. _
TOWN OF YARMOUTH
Permit Number
tr
PaI
BUILDING DEPARTMENT 1146
Route 28,South Yarmouth,MA 02664 5118.39&2231 ext.1261 Fax 508.398-4836 I , Date Tssu
• � Expiration Date
$50.00
TRENCH PERMIT
Pursuant to G.L.e.82A§1 and 520 CMR 7.00 et seg4as amended)
THIS PERMrr MUST RE FU LY COMPLETED PRIOR TO CONSIDERATION
Name rn 5 oLrnQC 'Moe Cell
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SCE-43a-55z -114-s3(,- 6ASa
Street Address Email Address:S(xaCYranexcciro3:r10pc@ho3/4'^13•obi
City/Town
NGrvvch IZ I oac MS
Name of Excavator Of different from applicant) Phone Cell
Street Address Sarnt
Email Address: I
cayITown IMA I z>p
Name ofOwDMS)ofPtopexty 0.1 fits Wftv 5 Phone Ceti
Street Address 15 I LI MA-7P D f E 1411-Let Email Address:
4)
Cityfrown MA ZIP
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Other Contact 1 Permit Fee Received No l 1 Yes f 1
Desaipdoo,location and purpose of proposed trench:
Please desmbe the exact location of the
lines etrench tc..)nesseand
its purpose
u reverse�s (Include
ide f deada description space of what Is intended)to
be bid in proposed trench(eg;pipes/bible l
same 1Ns?4ur 25127 P,111 +1X c- Vel RI)
fasm,nee Certificate it V w c - loo -io o as.cc f - ,90/6- ,g.
1 :Mame and Contact Information of Insurer.
I' - -P. t. M mAilweLQ ;5yhtYcA BvC 1gL) %ng sura o\36/3
: Palk,Expiration Date. t 'oil- I q /
IDig Safe k 18
a037 ,sT
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1 throe ScMrnSPec `defin�mo�It 0
2j RECEIVED
SEP 12 2018
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4. LleeiwCredos an . Expiration DM,: i 1 OS laoV
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BYSR:NiNG h1S'FORM:TRE APPLICANT,OWNER,*1W EXCAYATORALL ACEPIOW•LEDGE.AND CERTIFY
TBAtI'RR .ARE FAMILIAR WT171 OR,BEFORE COMMENCEMENT OF THE WORE,-WtLBECOME FAMILIAR
WITH;AIiL'I.AWSAND REGULATIONS APPLICABLE To,WOR[PROPOSED;INCLUDINOVSIIA;RBGULA•{'R)N3,
C.L.c'•d2A;.:52F-'CMR 7.N et, sees, AND AM AAPPLICABLE..MUNICIPAL•QRDiptjN FB, :BY-LIWS AND
RECUI:ATloNS:ANDTHEY COVENANT AND AGREE THAT ALL WORE DONEUNDER THEPERMIT ISSUED FOR
BMW WOR[WWILL Cosies THEREWITH IN ALL RESPECTS AND,WH7T THE.CONDITIONS SET.mint
• BEI:OW; •
• 7H4.UNOTiWSIGNED :OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE.PERMIT .AND•THE
EXCAXATOR.TO:UNDERTAXE SUCH.WORK ON THE PROPERTY OF THE OWNER,'AIME ALSO, FOR THE •
DURATION OF CONSTRUCT/ON, AUTHORI7ES PERSONS DULY APPOINTED'S?IRE inssarkun TO
ENTBR'UPON..THE;PROPPITTl To MONITOR AND mama TAE WOR[,'sot CONE7)RMYLY WITH THE
CONDHTONS ATTACHED HERETO AND THE LAWS AND REGULATIONS COVERING SUCH WOES • '
YHE7INDLRSIGNEDAPPLICANT,OWNERAND EXCAVATOR AGREEJOINTLY AND SEVERALLY_TO
REIMBURSE TBE MUNICIPALITY FOR ANY AND ALL COSTS AND'ERPENSESJNCURREp BY THE
MUNtiFALTTY IN CONNECYN)N WITH THIS PERMETAND THE WORE CONDUCT'S)THEREUNJFa
wICFiumIN6 ERT Nor LIMITED TO ENFORCING THE REQUIQ[NENISOr STAT;LAW AND CONDITIONS •or.. •
.
Taisresbot BVBPECTR)IM MADE TO'AS9URR COMPLIANCE Tummy*.AND
x
MUNFCnMLIflTOPROTECTTHE PUBLIC'WHBRETHE APPLICANT OWNER OR'EXC HA�STAH.EDTO•
COSMO TEEPEE/TO INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED. .
NECffiBARY,BY THRMUNICH'ALITY,
•nnotRIDI[YBitma APPLICANT.OWNER AND EXCAVATOR AGRE/JOIN LY AND-SEVERALLY TDDEFEND;
LL10OLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYS= •
.CAUSES OR ACTION;.COSTS,,AND .RESULTING,IHOMOR.:IRIS NG OUT
OF.ANY j1fQllRYi'J1R_A"I7i. :OR DAMAGE TO ANT PERSON.OR:pRofl DUR won
CQNDU(,'It:D UNDSRTH7S
APPLICANFSi ;
•
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EXCAVATOR NAT LIRE(IF..D
{ QPERE2V[).
'DATE , .9 9l)779
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