HomeMy WebLinkAboutBLDTR-19-002586 ll • II-IL-14. II.04HMi •OVOOV0VOJO * I/ L
e; " .; I gY:, Town OF YARMOUTH Fid(. rQ- (q-DoaseTb
• f' ° 1 o BUILDING DEPARTMENT Permit Num e
. a 4\/c . 1146 Route 28,South Yarmouth,MA 02664
,�l„` 4 508-398.2231 ext. Fax 508-398-0836 1 Date Issued
e 4.r.x.v i.. .. I
-• Expiration Date
$50.00
TRENCH PERMIT
Pursuant to G.G.c.82A§1 and 520 CMR 7.00 et seq.(as amended)
THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION
Name of Applicant S r1 S1eGfrnrk Plane Cel
q�f' ° n bcCrli.fick mei -k--C 5o3-y3a-556s -n4-g3 , ()Liza
Stray ddress
lees Qc er> w Email Address:Sp XoC.rrP,nexcwOfincpc@haimacol
City/TownA ZIP
NG. ch OaGAS
Nano of Excavator(it different from applicant) Phone Cel
Street Address same__
v Email Address: I
City/Town MA ZIP
Naar of Owner$)of Property W^ ,n�ta ry&arc Phone Cell
Street Address
Sri C Email Address:
City/Town MA ZIP
Other Contact I_Permtt Fee Received No( ) Yes t )
Description,location and purpose of proposed trench:
Please describe the exact location of the proposed trawls and its purpose(Include a description of what Is(or Is intended)to
be laid in proposed treads(c;;pipes/able Dom rtea Please use meat side if sd&tional space is needed.
63 mr 6c raj t- s•r- s0°71c (N,S L E C E 1 V E D
OCT 29 2018
oul� I ks �
kitei
, Insuranceaerx,rirate , WCC-Soo - 500 8256 a ate A
I Name and Conran Information of Insurer:
IRS OC. *ca. &r- t&p sIns co.154Zhtvdd Ave)8ur1(r,gkon mA 01Z63
,
:Polies Expiration tate. n1 ('1( 1�.o i"1
I Dig Sete t+: ao‘e t�-Lf c� 1573
flame of Competent Person las defined by 520 CMR 7.02):
SCkr \ Speo„V-rnan
1 of 2
I
1 .
OM Z JO Z
• . .
, .
'IP' 1 I till f t
aft, nit
ble
au uriptimpa—e—ff
Nit Ili MPS P.M-"am Issaarai AR.
... . .. ,
jT
a
a/ °a - i Z 4 of taLY i - , p7,
(LN322.1310.1) • ,ILLYN9122.2 ii/AO
_
---",
at
LLN3123.4.130 Al/aslant watvAiran
,
ZLYO
Mal YHDIS 11/Varaly
UWCJ SIRS*30W Cziamawoa
. _
IOWA MLL otaaaa Auciamia a0 Nomaial ANY as aormiya ao Iscri luitaraaalla ANY AO
zoo Mann•to won otarmar suradix any'sisal'moor 10 sawn-a°Litwin Try ahry ANY
NOV 221/02811101 ably HWY ELI AO TTY MN JLIZIYALIDION 301 liSTUCHVH WWII ONY 6IDZIOIDZI
YIN3A3U CU ATiVILIA2S ON Y XIINI0f101112w 1101VAV323 ONY ITANAto lairaTIMY 02N-912220Na OHL
eaulyanoway atu At ILYYSS232N
02.M1310 VAWISY2017Ylamall=ILO GUY funIDTIOd 040(IMNI ILLIA11222.11111Y03
CIL(EMU VVH MiLYAV322110 MAO INV3I'LLIY MU 3/0111M MAIN a WILLOW 01AATIUDINILW
28L MI N22Y,L 821110101(Dar Ii11/0122I1LIONYTLIK03 IIROSSY 011141VIV SN0(132.020.1111113181111.
10 SNOLLIONO3 ONY AV,It VIS£0 sucayonruiessa ELL Oranana al.anivaimati AIM%MINION!
VASIO3121114111300103=Oat a cum awizad suit MILK NOL13310403 NI ALTIVE3INow
Ea MI 0211211.110 SZSMaall CMV 91SO.3 TIY aNY ANY aal AillyanDifiN SEX ISIMIEWIn
01ATI1ILIAIS(INV 111.100,3313Y MaLYAY313(INV MAW 4INTJTIAilY OMOISSEINO EU
•
TWA%MOS Daan00 SNOLLY13335 ELY 5itY7 ELL cozy Oinall COODYJAYSNOLUCINO3
EU BUM LuharkilNO3 athivoloAt 2H1 LYMSNI ONY NOLD10111 01 /11121011d SILL /10410 22.11/1I
01 ILLt7YAL3INILIV MU is GAUGOadlY naa SNOSSLA fairomaLor •NommusNoa so yourana
ELL vat toy war Immo *31 10 =wow zu. NO 1101% loos arvaiuma az NOZVAVan
EU Wiry loam WU 110A AladY at .1.1.Y3rIALIY ELL SIMUOiliflY UNA° a3NII'
Waal Jays SNOUIGNO3 ELL olita run' toad= "TY ta ituataamu naval Twos XII0M. WES
Mal amisE 11101311ILL=ONO atioa UOM 17Y IV&2222Y IINY ANYNIA03 LIIIL CMV SNOCLY111222
any sarras tONYeaaao iyeauast rarrariatry ANY way eins SI Set aria Es VI v *TO
4SNOILYIIMI1•VIEO abnarrkva ErsociOad 210M OA alaY311W,SNOLLY210211 GNI`SIM"77Y•1111At
ityllaVYJThaln TaAs isacatt 331 40.1.paraatianit03 sauna*go'RUM ivennirti In LIELLYILL
AdUfl)ably 1190TLOON71.1Y'Mr HOIYAYan any giothatO litY3rudY ZELL loos Mal stalest As
h‘oe I sel ti nsaustwidis
• is
,
lid e *pun swap .
CIDj0 Y..1 --3-1 if Milan 111195PH linalgiainnit
..,
• ,, 1..1,
)