HomeMy WebLinkAboutTR-19-3879 to%, o1, YaR TOWN OF YARMOUTH pI�,Lr�.
o{ .cg 1b BUILDING DEPARTMENT Permit Number 19-b0329
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1146 Route 28,South Yarmouth,MA 02664
N.i...,. . 3' 508.398.2231 ext. 12611 Fax 508-398-0836 Date Issued
Expiration Date
$50.00
TRENCH PERMIT
Pursuant to G.L.c.82A II and 520 CMR 7.00 et seq.(as amended) '
TN1s PERMIT MUST BE FULLY COMPLETED PRIOR TO CONsmERA77QN
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(tion.location and purpose of proposed tnaetu
Please describe the exact location of the proposed trench and leaparpose ttnctudo•descriptJea of what b(or b ineroded)
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be tld In proposed trench lest plpaleabie Tina etc-1 Pie use rev eeae vWs If ti
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BY SIGNING TILIS FORM,THE APPLICANT,OWNER,AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY
THAT THEY ARE FAMILIAR WITH,OR,BEFORE COMMENCEMIIY'r OF THE WORK,WILL BECOME FAMILIAR
WTiII,ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED.INCLUDING OSHA REGULATIONS,
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SIA, 521 CMR 7.11 K sat,: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 ALL RESPECTS AND WnH THE CONDITIONS SET FORTH
BELOW.
THE UNDERSIGNED OWNER AUTHORITY-3 TICE" APPLICANT TO APPLY FOR THE PERMIT AND TILE
EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND ALSO, FOR.THE
DURATION OF CONSTRUCTION, AUTHORIZES PERSONS DULY APPOINTED BY TRE MUNICIPALITY TO
ENTER UPON THE PROPERTY TO MONITOR AND INSPECT"THE WORK FOR CONFORMITY WITH TSE
CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS COVERING SUCH WORK.
THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO
REIIBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSFS INCURRED BY THE
MUNICIPALITY IN CONNECTION WITH THIS PERMLTAND THE WORK CONDUCTED THEREUNDER
INCLUDING RUT NOT LIMITED TO ENFORCING THE REQUIREMEN'I3 OF STATE LAW AND CONDITIONS OF
THIS PERMIT.INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWITH,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 THE MUNICIPALITY.
THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND,
I/DE ISNIPY,AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYEES FROM
ANY AND ALL LIABILITY,CAUSES OR ACTION,COSTS,AND E CPENSES 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 SIGNAT
EXCAVATOR SIGNATURE(IF DIFFERENT')
DATH
OWNER'S SIGNATURE(IF DIFFERENT)
DATE:
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