HomeMy WebLinkAboutBLDTR-23-003347 TOWN OF YARMOUTH in (Li f/Lg
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'0. BUILDING DEPARTMENT Permit Number &O
›( 0!t' sr< c 1146 Route 28,South Yarmouth, MA 02664
0
,5, 508-398-2231 ext. 1261 Fax 508-398-0836 Date Issued
Expiration Date 0 I01>?
TRENCH PERMIT RECEIVED
Pursuant to G.L. c. 82A 11 and 520 CMR 7.00 et seq.(as amen DEC 1 5 2022
THIS PEiLMTT MUST BE FULLY COMPLETED PRIOR TO CONSIDERAno
BUILDING DEP;,; iENT
Nam of Applicant PKM Contractors, Inc. Mae Ce8 --— _
Street Address 313 Hokum Rock Rd-P.O. Box 775 508-385-5993 508-237-3328
City/Town MA ZIP
East Dennis MA 02641
Nauss of Excavator I different front applicant) Phone Cell
Street Addrist
CityiTown MA ZiP
Name of owners)of Property Karl Norton Phone Cell -
Address 508-394-4733
1 Street 92 Trowbridge Path
City/Town MA ZIP
West Yarmouth MA 02673
Other Contact 1 Permit Fee Received No C ) Yea( )
Description.locations and purpose of proposed trench:
Please describe the exact location of the proposed trench and its purpose(Include a descripdsn of what is for is intended)to
be laid in proposed trench lea;pipdeabie dues etc..)Please use reverse!ride itaddidotii space Is needed
Existing cesspools pumped, crushed and abandoned. Install new 1,500 gallon septic tank, distribution box,
and (2)500 gallon, H-20 concrete leach chambers.
Insurance Certificate If:
503-855672-4
`tame and Contact Information of Insurer:
Karen Cox-Eastern States Insurance Agency: 50 Prospect St. Waltham, MA. 02453
Nile? Etpiratbn D:Ne: 08/20/2023 -- -
Did Sala fh 20225002753
vans of Competent Peruse as defined by 520(MR 7.02):
Patrick K. McDowell
Iof2
r ,
Massachusetts HE-039080
tit�
' Lice•
nse Grady HE-2A 04/19/2024
Expiration Date:
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,ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS,
G.L. e. 1124, 520 CMR 7.0E et seq., 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 WITH THE CONDITIONS SET FORTH
BELOW.
THE UNDERSIGNED OWNER AUTHORIZES 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 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 JOINTLY AND SEVERALLY TO
REIMBURSE THE MUNICIPALITY FOR 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 OF STATE LAW AND CONDMONS OF
THIS PERMIT,INSPECTIONS MADE TO ASSURE COMPLIANCE THEREWFI'H,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,
INDEMNIFY, AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS 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.
APPLIC T SIGNATURE
'Y. �� DATE _12/13/2022
EXCAVATOR SIGNATURE(IF DIFFERENT)
DATE
OWNER'S
SIGNATURE I IF DIFFERENT)
�l• /t 4. .fr _------ --------- DATE: 12/13/2022
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