HomeMy WebLinkAboutBLDTR-19-002494 •
•
ir ot'Y444 TOWN OF YARMOUTH
3' . ,.V! o BUILDING DEPARTMENT ' Permit Number&ID 7f2 -/f7-ay
• n� "`2, 's y 1146 Route 28, South Yarmouth, MA 02664 ,�
!- •• Sox-398-2231 ext.1261 Fan 508-398-0836 Date Issued
' Expiration Date
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$50.00 •
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• TRENCH PERMIT
'Pursuant to G•.•L.c.82A §1•and 520 CMR 7.00 et seq.(as amended)
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/mss PERMrr MUST BE,FULLY COMPLETED PRIOR TO CONSIDERATION
Name of ApplicantC!tc-�.�e !1 4 Mercktisit--.! Phone
Street Address Cell
s tJcwt i.wi p1 • • . ��8 �►i.t� D$ 39�-10►D
C /Totrn • ' INA I ZIP . .. • •
• D 39 ,
Name of&ignitor(Ifdtff from applicant)
• Phone •Cell
Street Add e' •e -r4 -VP u 1►a-1 t, • • •3 0g ' 6789 . 877
X51 -rmale,'i ,16 �-�.4,:�. .
Cit 1rp rn MA• Zn, ,. , • .
Na`me4C/Jofl, to 0-1,51
rctlln `�' P� . •Cell ,
Id
Street Address
33 Lakt goad •. . r5600P)9(95'3E3 -3
City/form MA ZIP
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Wt* ittlen40 l to In
Other Contact
Desertpilo, location and purpose of proposed trench
Please describe the exact location of the proposed trench and its
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be laid In proposed trench(egt Plpe�n41e lines ete.)Pleaseµse reverse side If additional space lest hatis a J1 _ c
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1= eve
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• • • 6 n,,,�,"; OCT 2 s 2018
`QO 1 ' EUILDING DEPA R_T _MEP
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Insurance Certificate Mt * n n 1
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Name midi Contact Information of Insurers
P-01 els chtzt &7 1 . )rrailta wt.e. $ •39$•791
1 Pol Ex.!ration Dam. 1.13E57LS •
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miser"
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Name of ompettnt Person 1 • nett by 520 CMR 1.02u
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