HomeMy WebLinkAboutBldtr-20-003950 , � �• TOWN OF ' AR UTI
T'
BUILDING DEPARTMENT Permit Nu be�'�
y 1146 Route 28,South Yarmouth,MA 02664
c34 4' 508-398.2231 ext. 1261 Fax S08-3984 Date Issued
Expiration Date
$50.00
TRENCH PERMIT
Pursuant to G.L.e.OA 11 and 520 CMR tee et seq.(as amended)
THU PUMIT MUST t8 MU CaiIPL DiMl1OR TO COHIJD ATmN
Name spAp nt Paul C ciNcoAr%r, Phan.
WLiCc$6 c be rvtotb C C
mina
City/T w* MA ZIP
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a we 0 Excavator tR Mee*hou l Phone Cill
Street Address
c~itylrows' DIA ZIP
Nor aatOw ls)of Preperty :77-a 4 of ,5.o�.rre-0-' 'ph Cell
*not Miklos
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Mbar Contact I Permit Roe itectivai No t ) Yes t )
0411131pe*Won sad purism of yroposes1 trends:
Please describe the ems location et the propped trench sad its purpose(l eehi li a description of wise*is(ar is intended)to
be laid la proposal trench tent pa it lass etc..)!'feast ins mono miie it additional space Is needed.
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SY SIGNING TENS MEM.THE APPLICANT,OWNRR,AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY
THAT THEY ARE FA1NEUR WITH,01,SUCRE COMMENCEMENT OW THE WORK.WILL BECOME TAM1UAR
WITIL ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROSED,INCLUDING OSHA REGULATIONS.
„G 124, sal CMS 7.N d , AND ANY APPLICABLE MUNICIPAL ORDINANCES, BYLAWS AND
REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORE DONE UNDER THE PERMIT ISSUED I+OR
sum won WILL COMPLY TIIZREWiT I IN ALL itEarzers AND wins THE CONDTTIOM SET FORTH
MEOW.
TIN UNDERSIGNED OWNER ALtTHO THX APPLICANT TO APPLY FOR THE PERMIT AND 'TIC.
EXCAVATOR TO UNDERTAKE SUCH WORK ON TER PROPERTY-OP TIE OWNS*, AND ALSO, FOR THE
DURATION OP CONIIIII/CITON, ,AUTHORIZES PERSONS DULY APPOINTED BY THE t UNICIPALITY '
ENTER UPON THE PROPERTY TO scoriton AND INSPECT THE WORE FOR colorant= WTIll THE
CONDITIONS ATTACHED IIERITTO A,ND`THR LAWS AND R .TR COVERING SUCH EMIL
THE UNDISSIGNEDAPPLICANT,OWNER AND EIWAVATt}R AGREE JOINTLY AND SEVERALLY TO
REIMBURSE TEX MUNICIPALITY FOR ANT AND ALL COSTS AND MENU,'INCURRED SY THE
MUNICIPALITY IN CONNECTION WTTII Tilt PERMIT AID TEE WORK CONDUCTED THEREUNDER.
INCLUDING BUT NOT LIMITED TO ENFORCING TiRI REQVIREMENTI OP STATE LAW AND COMMONS 0?
THAI PERMIT,INN3F'WflOPS MADE TO ASSURE COMPLIANCE Tnurprrni,AND MEASURES TAN EN SY THE
MUNICIPALITY TO mower THE PUBLIC WHERE TEE APPLICANT OWNER OR EXCAVATOR HAS FAMED TO
CoeuY T EWTTH INCLUDINGPOLICE DETAILS AND OTHER REMEDIAL MEASURER noun
NECESSARY IIY Tin MUNICIPALITY.
THE UNDERSIGNED APPLICANT.,OWNER AND EXCAVATOR AGREE JOINTLY AND SE IRALLY TO Dom,
IHDIEMN1Fti',AND Rom HARIMIES THE MUNICWALTTY AND ALL OW ITS AGSMS AND EMPLOYEIS FROM
ANY AND ALL LIABILITY,CAUSES OR AMON,COSTS,AND EXPOSES RRS,ILjTING FROM OR ARMING our
OP ANY MARY. DEATH, LOSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORE
CONDUCTED UNDER THIS PERMIT.
APPLICANT SIGNA
_ DATE //5'/mod•
EXCAVATOR SIGNATURE(IF DIFFERENT)
DATE
OWNER'S SIGNATURE t IP DIFFERENT)
DATE:
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