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HomeMy WebLinkAboutBLDTR-23-005445 TOWN OF YARMOUTH nv•YaR- z d d S—VY5" 4 BUILDING DEPARTMENT PermifiLD7/Z- umber ` A( r4 y 1146 Route 28,South Yarmouth,MA 02664 Ol -ram�'. ;Y '• ,,," ,�y' 508-398-2231 ext. 1261 Fax 508-398-0836 Date Issued Expiration Date $50.00 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 CONSIDERATTON Name of Applicant Phone Ready Rooter Excavating 508-888-605;3�� 508-509-0802 Street'tak es PO Box 89 Clty/i'own Forestdale rMA I IP02644 Name of Excavator lit differentfrom a pplicant) Phone Cell Street Address City/rown I MA ZIP NaaetofOvnerislofProperty Marcia Ricketts Phone Cell Street Address 442 West Yarmouth Road 508-241-4669 CteyITowe I MA ZIP West Yarmouth 02673 Other Contact r Permit Fee Received No( I Yes lx) Description,location and purpose of proposed trend: Please describe the exact location of the proposed trench and its purpose(include a descripden of whet is(or is intended)to be laid in proposed trench(es;pipes cable yaks etc..)Pima use revert side it additional space is needed. Install 1500 gallon septic tank - - and 2 500 aallon leach chambers in front of property. RECEIVED MAR 312023 BUILDING DEPARTME Insurance Certificate o: WWC3523550 Name sad Contact lnforn atlon of enure,W uran ce 420 Maple Ave., Yukon, YK7'3O99 405-354-5201 Pnl ki Fepiration Date: 04/1512U2 3 Dig Sah s:2023-1102664 Name of Competent Perms(as defined by 520 CM*1.02,: Patrick Sullivan 1of2 f mess mating Limn* H E 144345 mowGrades . 2A 1 C 11/05/2023 E;t►irtaMs D iY SIGNS TINS FORM,THE APPLICANT,OWNER„AND EXCAVATOR ALL AC TEAT THEY ARE FAMILIAR W O1,WORE CU ILL DELI AND CRRTYAY ' ALL LAWS AND REGULATIONS APPUCAILE T O WORE THE K;WILL O PAiMN.IAE PwONMEDI INCLUDING tMILI C a i3A �. CMR TA 0 seq., AND ANT ; 14 4 $Am A�PlIiCA,IE �Ad. ORLILII►"L1 TIOND AND not COVENANT AND AGREE THAT ALL Wt DONE THE >t'Ml'EI A!!N SUCH , WILL COMPLY THEREWITH IN ALL UTINR o lid" PO' LOW �'ECAI AND WITH THie comment_ Ton unnagrucpans OWNER AUTNORuRR TIM APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROSERTY OF THE OWNER. DURATION OIAND NICIP FORLIT THE ' UPON THE PROPERTY TODULY SY THE MUNICIPALITY TO .. COUDirI'IOND ATTACH®HRSE'hO AND THE LAWS INSPECT REGULATIONS WORE !N SUCH Wiyp R " REGULATIONS COVERING SUCH WORK. TIst UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE TIN MUNICIPALITY FOR ANY AND ALL COSTS AND Y AND StifERaII:H TO MVNSCIPAU[TT IN CONNECTION WITH THISS�1Y THE INCLUDING NDJL'Nat I.ti1,1'i'N1 PERMIT AND THE�[CfHVpUI,'Tlilf TNHlRQ)lVlf� THIS PERNitIT,m Nat DWI MADE ro TfN 1ENTS or STATE LAW AND C�OF NiumapALTLT TO P ROTICT THE PUBLIC WH;Rs THE AMR wolrLEANCE * 'AND MEASURES RAS'SY THE COMPLY TmlWRy INCLUDING POLICE BRIARS AND f�R OWNER�EXCAVATOR 'MUD TO NECESSARY SY TIN MUNICIPALFM THR ANY UNDERSIGNED N AP HAMMENOWNER THE AND EXCAVATOR AGREE AI.ITY AND ALL�JO MI>NNrI'LY AND SEVERALLY YO DEFEND, ROM ANY AND ALL LIAaRI7'T,CA( on ACTION,COOTS,AND uLTI I AND B OR AR NN MOM o ANY NiURY, DRATH, LIMA, OR DAMAGE TO ANY A�fJCTL1Yti I> OR ARdpyW our CONDUCTED UNDItR'YID PERMIT PROPERTY DURING.TOR WORK APPLICANT SIGNATURE , ---=527-----------.' DATE ....741,2-.Z3__ TOR SIGNATURE iIF©IEEE `- - 1 _ ..DATE W SIGMA RFC ,�..= ors: / 1..L!::: Ill :: .i,T.:i i-I'i_.4, ..11111LIHHIMIMMIIINIll.t im...............____ rimr"'" ' , 2 of