Loading...
HomeMy WebLinkAboutBLDTR-23-005868 , Y � ��TOWN OF YARMOUTH 0 -Z 3-o �OS� F gR%( ; BUILDING DEPARTMENT Permit Number 41.11e4. 1146 Route 28,South Yarmouth,MA 02664 Ot - •Ic" 4 03,4, 508-398-2231 ext. 1261 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) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant Phone CeN PKM Contractors,Inc. (508)385-5993 (508)237-3328 Street Address 313 Hokum Rock Rd-P.O.Box 775 City/own MA ZIP East Dennis MA 02641 Nave of Excavator(it fferent har e applicant) ' Phone ea �' IV D Sinai�►�* ,P' 18 2023 City/Towns MA ZIP BUILDING DEPARTMENT BY Noar at Owners)of Property Todd Olson Phone Cer Street Address 7 Victory Lane CRyffown MA ZIP -4 South Yarmouth MA 02664 Other Contact I Permit Fee Recehed Not 1 Ye i ) Description,location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose(Include a description of what lo(or Is intended)to be Ladd In proposed trench(es;pipes/cable Nat etc..)Plese on reverse ride itadditional space is needed Pump and remove existing SAS and install(4)high capacity infiltrators Insurance Certificate Ns 503-872657-2 Name and Contort information of Insurer: Karen Cox-Eastern States Insurance Agency:50 Prospect St.Waltham,MA.02453 PaNcy I!Lepirotion Pate 08/20/2023 Dig 586"p' 20231315028 ( Name of Competent Penes is defined by 520 CM*7.02): 1 Patrick K.McDowell I of 2 ifesseeinnette Hoisting License P HE-039080 Lceme Grads: HE-2A Espttstiow Date: 04/19/2024 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 WTTLI.ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS, G.L. e. SA, 520 MR T.N et seg., 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 CONSTRUCTKIN, 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 WORE. 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 TN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER, INCLUDING RUT NOT LIEUT ED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF THIS PERMIT.INSPECTIONS MADE TO ASSURE COMPLIANCE THERTiwrru,AND MEASURES TAKEN BY THE MUNICIPALITY TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY TTIEREWTIH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE MUNICIPALITY. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND, INDEMNNY,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, L.OSS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT. APP ANT SIGNATURE W1? , ` DATE April 13,2023 EXCAVATOR SIGNATURE(IF DIFFERENT) DATE OWNER'S SIGNATURE(IF DIFFERENT) 76 ©/n DATE: April 13,2023 Mays*we—lib img*aft ilaskitrontisa L tit. um 2 of