HomeMy WebLinkAboutTR-19-1714 -..,0.7,-,.„ TOWN OF YARMOUTH .,DT2- (q.-(0171 y
/a—ADEPARTMENT
_ BUILDING � ;N'C Permit Number
o' C 1146 Houle 28.South Yarmouth, NIA 02664
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\...':1-,..4 :118.3')8.2231 ext. 1261 Fax S08-395.0834 Date Issued
Expiration Date
-= - 50.00
TRENCH PERMIT
Pursuant to C.L. c. SM §1 and 520 CMR 7.00 et seq.(as amended)
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pCOMPLETED PRIOR TO CONSIDERATION
Name of Applka p 1�1 V , W IVB IGYt i Qs. rw - Cell
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Description,location and purpose of proposed trench:
Please describe cproposed
the exact location of the proposed trench end its
be laid In xd trench( purpose(Include•dexrlptioe of what it for is intended)to
leg;pipes/cobk Noes etc..)Please use reverse Jilt if additional space Is needed.
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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.
CL. e. CA, S2B CMR 7.11 d seq.. AND ANY APPLICABLE MUNICIPAL ORDINANCES. BY-LAWS AND
RECCT.ATHONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR
SUCH WORK WILL COMPLY THERBWTTH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH
BELOW.
THE UNDERSIGNED OWNER AUTHORLIES THE APPLICANT TO APPLY FOR THE PERMIT AND THE
EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY Or THE OWNER. AND ALSO. FOR THE
DCRATION Or CONSTRUCTION. AUTHORIZES PERSONS DULY APPOINTED BY THE MUNTCIPAIITY TO
ENTER UPON THE PROPERTY TO MONTTOR AND INSPECT THE WORK FOR CONFORMITY WITH THE
CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS COVERING SUCH WORE.
THE UNDERSIGNED APPLICANT.OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO
REIMBURSE THE MUNICIPALITY FOR ANT AND ALL COSTS AND EXPENSES INCURRED BY THE
MUNICIrAJTT IN CONNECTION WITH THOS PERMIT AND THE WORK CONDUCTED THEREUNDER.,
INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS Or STATE LAW AND CONDITIONS Or
THIS PERMIT.INSPECflONB MADE TO ASSURE COMPLIANCE THEREWITH,AND MEASURES TAKEN BY THE
MUMCIPALrTY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS PAILED TO
COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURE!DEEMED
NECESSARY BY THE MUNICIPALITY.
THE UNDERSIGNED APPLICANT.OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND.
INDEMNIFY,AND HOLD HARMLESS THE MUNICIPALITY AND ALL Or ITS AGENTS AND EMPLOYEES FROM
ANY AND ALL LIABILITY.CAUSES OR ACTION,COST'S,AND EXPENSES RESULTING FROM OR ARISING OUT
OP ANY INJURY. DEATH, IHSS. OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK
CONDUCTED UNDER THIS PERMIT.
APPLICANT SIGNATURE
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EXCAVATOR SIGNATURE IIP DIFFERENT)
DATE
OWNER'S SIGNATURE IIF DIFFERENT)
DATE:
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