HomeMy WebLinkAboutBLDTR-19-001448 pf'••'AR TOWN OF YARMOUTH Building Department BUILDING
_� �O (508) 398-2231 ext.1261
y PERMIT NO !BLDTR-19-001448] PERMIT
des. -;,v ISSUE DATE '09111/2018 JOB WEATHER CARD
APPLICANT ;Capewide Enterprises 1 PERMIT TO
AT(LOCATION) 12 SQUANTO RD,SOUTH YARMOUTH, MA 02664 I ZONING DISTRICT I 1 Bldg.Type:
SUBDIVISION MAP BLOCK LOT 033.7 BUILDING IS TO BE: CONST TYPE USE GROUP
REMARKS Trench-septic installation(508-477-8877) CONTRACTOR
LICENSE
AREA(SQ FT) 417,435,480. EST COST($) PERMIT FEE($) 50.00
OWNER GRIBBONS THOMAS R BUILDING DEPT BY
ADDRESS C/O R BARBIERI/THOM R GRIBBONS,50 RIC
WORCESTER MA 01602-1202 PHONE
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE
APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE
OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM
MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE SEPARATE
CONSTRUCTION WORK 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL PERMITS ARE REQUIRED FOR
FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE.WHERE ELECTRICAL PLUMBING/GAS
MEMBERS(READY FOR LATH OR FINISH COVERING) IA CERTIFICATE OF OCCUPANCY IS AND MECHANICAL
3)FINAL INSPECTION BEFORE OCCUPANCY 4) REQUIRED,SUCH BUILDING SHALL NOT BE INSTALLATIONS.
REFER TO DETAILED INSPECTION SCHEDULE OCCUPIED UNTIL FINAL INSPECTION HAS
BEEN MADE.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTIONS APPROVALS
OTHER: I
WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS INDICATED ON THIS CARD
UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE
APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION.
STAGES OF CONSTRUCTION AROVF
•-• TOWN OF YARMOUTH
CFyABUILDING DEPARTMENT Permit Number Bib-712-stYv
. H1146 Route 28,South Yarmouth,MA 026642' 508-398-2231 ext.1261 Fax 508-398-0836 Date Issued
•
Expiration Date
$50.00
TRENCH PERMIT
Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended)
THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION
Phone Cell so
Name of Applicant d_ALT-.at'.��
t:APaw/DC DtSeSIRQo So&-Len-STs't7
Emayyil AddresM
StreetAddress
153 dOetti RC(.(C. Sr- ,o 'C0
City/Town MA ZIP
M4S4oer kit 6)- / .
Name of Excavator(if different from applicant) Phone Cell
Street Address
•
Email Address:
City/Town MA ZIP
Name of Owners)of Property 74445 GrRIGE.31.)$ Phone Cell
Street Address (bfJCaGC. Fr DA'ctt COX)
a 56160/14-1,0 ito4b / Email Address:
City/Town MA ZIP
50 cJrck- ‘6412;4car4t`IA OX(06 `'-
Other Contact Permit Fee Received No Yes 1
Description,location and purpose of proposed trench: I
Please describe the exact location of the proposed trench and its purpose(include a description of what is . i . • .p
be laid in proposed trench(eg;pipes/cable lines etc..)Please use reverse side if additional space is let C E
5'c---zit t C., -POS- �4f 00 SEP
112p %
6u IMG DEPAR_____ff
ILD — �
Bv'
i Insurance Certificate k: C pk t3 o( ce)..8 as
Name and Contact Information of Insurer:
14v •Z',uzEeznstr ac, ikA•C. C4-7-±1-62-adC LCWWPc�cC
Polk y Fspiration Date: a- ( -sa ( S
Dig Safe M: ao i 2 3s0i4-1 i4-1 a9
Name of Competent Person las defined by 520 CMR 7.02):
C74414 Eg 7300544)cT
J.
Name of Competent Person(as defined by 520 CMR 7.02):
MMES TP , D ul ,4ocr
Massachusetts Hoisting License# H E (S1 a( Q //
License Grade: H2 -' a4 Expiration Date: CS` /2 - a()r9
BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY
THAT THEY ARE FAMILIAR WITH,OR,BEFORE COMMENCEMENT OF THE WORK,WILL BECOME FAMILIAR
WITH,ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS,
G.L. c. 82A, 520 CMR 7.00 et seq., AND ANY APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND
REGULATIONS AND THEY COVENANT AND AGREE T IAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR
SUCH WORK WILL COMPLY THEREWITH IN A' RESPECTS AND WITH THE CONDITIONS SET FORTH
BELOW.
•THE UNDERSIGNED OWNER AUTHORIZES T APPLICANT TO APPLY FOR THE PERMIT AND THE
EXCAVATOR TO UNDERTAKE SUCH WORK O. THE PROPERTY OF THE OWNER, AND ALSO, FOR THE
DURATION OF CONSTRUCTION, AUTHORIZES ..ERSONS DULY APPOINTED BY THE MUNICIPALITY TO
ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE
CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERING SUCH WORK.
THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO
REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE
MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER,
INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF
THIS PERMIT,INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH,AND MEASURES TAKEN BY THE
MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO
COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED
NECESSARY BY THE MUNICIPALITY.
THE UNDERSIGNED APPLICANT, OWNER AM) EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND,
INDEMNIFY, AND HOLD HARMLESS THE MUNICIPALTTY AND ALL OF ITS AGENTS AND EMPLOYEES FROM
ANY AND ALL LIABILITY, CAUSES OR ACTION, COSTS,AND EXPENSES RESULTING FROM OR ARISING OUT
OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK
CONDUCTED UNDER THIS PERMIT.
APPLICANT SIGNATURE .
—11‘21.,cr DATE 9-11 '2,0(�
EXCAVATOR SIGNATURE(/IF DIFFERENT)
Y- Q�l DATE `-tl -).O (S
OWNER'S SIGNATURE�(IF DIFFERENT)
DATE:
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