HomeMy WebLinkAboutBLDTR-19-002803 %' • ff Y9R TOWN OF YARMOUTH BuY-12—t q—ppm-O3
t .•ot e So BUILDING DEPARTMENT Permit Number
1146 Route 28,South Yarmouth,MA 02664
rt_... 4' 508-398-2231 ext. 1261 Fax 508-398-0836 Date Issued
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Expiration Date
$50.00
TRENCH PERMIT
Pursuant to C.L.c.82A 11 and 520 CMR 7.00 et seq.(as amended)
TNLS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION
Name of Applicant Ready Rooter Excavating Phone cell
Street Address PO Box 89 508-888-6055 508-509-0802
City/Town MA ZIP
Forestdale 02644
Nos of Excaeatoe lif different from applicant) noes Ceti
Street Address
City/Town MA ZIP
Nees of ow,atts)of R.Peet3RDbert Herrera Pesea Cee
Stfeet Address 554 West Yarmouth Road 508-737-9321
City/romsl MA ZIP
West Yarmouth I 02673
Other Contac I Permit Fee Received No 1 ) Yea t l(
Dentition.lwtNu and purpose of proposed treat
Please describe the exact heatim of the proposed trench and its,_ nuchae•description of abed le or 6 intended)to
be laid 1n proposed trench fest pipse/nble lines roe-)Please use mine idde If additional space Is needed.
Install new Title 5 leach field in rear of property. RECEIVED
LNOV 07 2018
BUILDING DEPARTMENT
sy
i Insure Cenifkats Pt
WC5-31 S-390198-18
Nita
andCelia"
intornatendInsurer; Liberty Mutual Insurance
PO Box 2027 Ke ne, NH 03431
Pocky F_epirnlon Mtn 04/15/2019
Wi 2018-4507132
Yana of Competent Penna I"
defined by 520(MR 7A21;
Patrick Sullivan
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Mv«fiesetu IloSMg License l HE-144345
Liam Grades 2A 1C Expiration Date 11/05/2019
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,AU.LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED.INCLUDING OSTIA REGULATIONS.
G.L. e. EIA. SIE CMR 7.N at sed,. AND ANY APPLICABLE MUNICIPAL ORDINANCES. BY-LAWS AND
REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR
SUCH WORK WILL COMPLY THEREWITH IN AU. RESPECTS AND WITH THE CONDITIONS SET FORTH
BELOW.
THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND TIN
EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF TBE OWNER. AND ALSO. FOR THE
DURATION OF CONSTRUCTION, AUTHORIZES PERSONS 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 COVERING SUCH WORK.
THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE roomy AND SEVERALLY TO
REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE
MUNICIPALITY IN CONNECTION WITH THIS PERMTTAND THE WORK CONDUCTED THEREUNDER,
INCLUDING RUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS or
THIS PERMIT.INSPECTIONS MADE TO ASSURE COMPLIANCE THERSWrrp,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'ME MUNICIPALITY.
THE UNDERSIGNED APPLICANT.OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEPEND,
INDEMNIFY,AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF TTS 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
5 DATE /0(7//r
EXCAVATOR SIGNATURE Ur DIFFERENT)
DATE
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