HomeMy WebLinkAboutBLDTR-19-003411 TOWN OF YARMOUTH BLI)7R-P-OiCNI
og 1 146 Route 28,South Yarmouth,MA 02664 -Permit Numberr= S BUILDING DEPARTMENT -P
', ..,,.; .2' 508-398-2231 ext. 1261 Fax 508-398-0836 Date Issued
Expiration Date
TRENCH PERMIT
Pursuant to G.L.'c. 82A 11 and 520 CMR 7.00 et seq (as amended) <,
THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION
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Pkat describe the act intim of the proposed trench sad its perms,(include a doeripike of what b(ser to t
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proposed trench(es;pipdeal*Bat Ma Mese use norm ride If additional spats Is thin k! euaded)~' J
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DEC 04 2018
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Naw sad Conran Information of Insurer:
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Name of Competent Pena to defined by 520(SIR 7,I2b
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Linnet Grades Expiration Dates 211312-o
BY SIGNING THIS FORM,THE APPLICANT, OWNER,AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY
TEAT THEY ARE FAMILIAR Wins,OR,BEFORE COMMENCEMENT OF THE WORK,WILL.BECOME FAM
WITH,ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS.
e. F2A, 529 CMR TN d sec. AND:ANY 'APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND
REGULATIONS AND THEY COVENANT AND AGREE IIIAT ALL WORK DONE UNDER THE room ISSUED FOR
SUCH WORK WILL COMPLY THEREWITH IN ALL RESPECTS AND WITH THE COMDMONS SET FORTH
BELOW.
THE UNDEASIGNED.OWNER *oniony:a THE APPLICANT TO APPLY FOR THE PERMIT AND THE
EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER. AND ALSO, FOR THE
DURATION Of CONSTRUCTION. AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPALITY TO
•ENTER UPON Tint PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY wins .THE
'CONDITIONS ATTACHED HERETO AND in LAWS AND REGULARONS COVERING SUCH WORE. • ' • '
TIM UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO
REIMBURSE THE MUNICIPALITY MR 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 or mu LAW AND CONDITIONS or
THIS PERMIT.INSPECTIONS MADE TO ASSURE COMPLIANCE nnutzwrrn,AND MEASURES TAKEN BY THE
MUNICIPALITY TO PROTECT In PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO
COMPLY THEREWTTH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED
NECESSARY BY THE MUNICIPALITY.
.„
THE UNDERSIGNED APPLICANT.OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND
INDEMNIFY,AND HOLD HARMLESS IRE MUNICIPALITY AND ALL Of ITS AGENTS AND EMPLOYEES FROM
ANY AND ALL LIABRITY,CAUSES OR ACTION,COSTS,AND EXPENSES RESULTING FROM.OR ARISING OUT
Of ANY INJURY, DEATH, LOSS, OR DAMAGE TO. ANY PERSON OR PROPERTYCDIMING-„THE I WORK-'
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EXCAVATOR SIGNATURE OF DIFFERENT)
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DATE
WNER' SIGNATURE(IF DIFFERENT)
DATE:
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