HomeMy WebLinkAboutBLDTR-19-003565 '`rCrtiki. TOWN OF YARMOUTH ;
i. Q ° BUILDING DEPARTMENT Permit 1VtimlSe — �9 3c65
_ y 1146 Route 28. South Yarmouth. MA 02664
,,;• js`d'Z 508-398-2231 ext1261 Fax 508-398-0836 Date Issued
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Expiration Date
$50.00 •
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TRENCH PERMIT
• •Pursuant to G.L.c.82A §1.•and 520 CMR 7.00 et seq.(as amended)
This PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION
Name of Applicant/1 im:it „.. _i fiierck�(id .'e Phone
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streeeaddretas° Niatt4i.Wl Rel • . .50 S'3..9$' IL° Sb$•3q4-1010
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Name oftear Of dilerfa from applicant)
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Name of
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(Tanen) Property: Ph". • .Cell •
str�eetg M Cavern
City/Town s K. . . J' Jho 9 - 005-_0346
MA ZIP
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Other Contact
Description,location and purpose of proposed trenli
ch;
Please describe the exact location of the proposed trench and its
be laid In proposed trench leg;plp&abk lines etc )PleaseµSe ree purpose
Jr sdd(attonal pace Iion Ineeded,abet J o Mended)to
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Insurance Cen9il
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Name and Contact Information of Insurer:
89-elS crud (9 s )nn4diuLtAte. ZDS -39$.--791 .7
Pot Et•'ration Date!. •ICIPTA is
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Name of nmpetept Person
ned by 520 CMR 7.02);
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�HoloingLleeme6r'Q�.571r-- '
License ` p
Grade: , a—�../9' '/ °��•7-0C / ,
} a 'leaden Dike:
BY SIGNING'IM MORN,THE APPLC� Off �
.AND
MT ARE
WIT
EXCAVATORAIL L AND coaxer
THAT
w OR;BEFORE COMM/CEMENTOFTHE WORE,WILL BECOMEFMegrim
vs GxATIONAPPLyCABLE TO wont ROPOSED,IICLDG OSA,RGDIAToN3,GL e. SU, 520 T700
et seq., AND ANY
ABIR
AND
REG
sum
�ITIONS AND THEY COVENANT AND AGREE ALL WOREDONE UNDER�g FOR
wRR u j COMPLY ]N ALL RESPECTS AND VIII$ T CONDITIONS SET FORSRIOW.
TM mU EEE UNDERSIGNED OWicR To _AVTnonz FS TAS
EM
DURATION Offi C � T
ONSTEucnol.7�TORTS PRS NS OFF THECANT TO Y p i ALSO, FOR r in IHUNKIPALLEY To
ENTER. UFONDirnoNB AT OAND THE LAWS O MONITOR. AND AND num
THE W� CONFORMITY WITH TO
THE UNDERSIGNED REGULATIONS COWERING ST/CH WORK ��
RBDiB> 'TRE�ALITYFOR.ANSANDALLcornAND AcREEAONISAPPLICANT,OWNERAND EXCAVATOR SEVERALLY TO
RENSESINCORRRO BY TER
maUDIN BG OTNOT COPMECTIONW PERMIT AND THE WORK CONDUCTED THEREER.
LIMSTE°TO ENFORCING TUEREQUIREMENTS OF STATS LAW AND CONDITIONS OF
THIS P ?GATT INSPECTIONS
EZcnTO Ej MM to,ASSURE THEREWITH:_
MUNIcorieCY INscrrozMMIX APPLICANTORE$�HAS FAILED
NECESSARY BY � . .r DETAIISAND OTI IiREt1ffiDIALA�pIIKKED
TO
M TINDERSICNED
T AND
ALL
HOLD g THE AND ESCAVATOR AGREE JOINTLY AND
SEVERALLY TO ANY ANY A A L UAsr ITY,CAUSES OR OR DAMAGE AND MUNICIPALITY AND ALL EOXPENSES
R ULTI I$AND EMPLOYEES ARISING
FROM
OUT
CT UNDER. LOS $TPN RESULTING FROM OR AR7SII4G OUT
TINE, LOSS,: ANY ORNPROPERTY bURiNG THE WORK .
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APPLICANT SIGNATURE • r
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.1/. _ _ BATE II 1 o
CA4ATORSIGNATURR(ylrEFFERENT)
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