HomeMy WebLinkAboutBLDTR-23-005932 in611
O'Ff4" TOWN OF YARMOUTH ii/2-la/4J
40, BUILDING DEPARTMENT Permit Number 5 Vb - 3-
1146 Route 28,South Yarmouth, MA 02664
508.398-2231 ext. 1261 tax 508-398-0836 Date Issued 0 0 5 q 3 2--
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Expiration Date CK24--
$50.00
TRENCH PERNIIT 1RECEIVFD
Pursuant to G.L.c.S2A f 1 and S20 CN1R YAM)et soq.(as antendeti)
rAPR 26 2023
TITS PERNITT MUST OE FULLY COMPLETED PRIOR TO CONSIDERATION
UILDING DEP RTM
Nate*air Applicant 6 3 izto,,it,ai tykt., Phone Ca I Bay P` ENT
Sired Adlited 98- till-o4 ,3
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City/Town MA ZIP
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Street Address
City/Town MA ZIP
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City/Town MA IZIP
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thine Contact Permit Pt*Eece4ed ) Yes 1._
Deseription.Weediest and purpose of proposed treneln
Phase divot*the teen Saddled of the proposed sans&sod its wpm.(include a description of what is tor is intended)to
he hod to proposed trench(es;pipttikablit Saes ete.)Please ass merit side Wadditional space Is nook&
51-0A Oaf Oi
insorstwe Cenintate es
52511+81.
Name sad(sowed termiedion of Insurer!
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Policy intion Moe: SI tl)fli
54.* 202,3 12-0 (12-it
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of 2
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BY SIGNING THIS roam, TILE APEL3CANi',DEN TUT rely A F,iM ER,AND LECA 'A E ALL ACI NcrINT DGE AND 71 i ri
wart ALL LAWS AND TIA �OIL I�RiC COMM NI fT or THE wD
GI_ 14 AltLUCARLE TO W�I wiLL SE COME RATi.i,VE
II;EGL'i.A� � CMR /.E �t ,, AND ANY EiA L ORMA RY-114,A
R wog* AND THEY COVENANT AND AGREE THAT ALL AL«E WORK
DONE #m - 'M AND
ECIS AND W/711 THE CoNDITTONS SET Foam
BELOW. ` K'H.[. CD1�lT'LY 7REVYIt� IN W ?Rtl R THH)�ERIT�►EDIE
THE NDE j U WNER AUTHORIZES Ilia E SUCH WORK APpucAIY
EYCATAt 1 tom' )t/N 7 RU KE S ,����. ANY FOR T D ALSO:AN FOR
THE
PERsesel I tt►t� OFT OWNER' AND
ELATED �A THE PROPERTY TO MOI�R AND toix !nC "THE sumariturY to
TO AND THE LAWS AND WORK FOR CONIVEMITYR `. WITH
THE�DIt�iCNJ� � SUCH WORK.
RETADRIIIMI AI .IGAi�T,OWNER AND EXCAVATOlt A Y
TEE MUNiC1PA POE ANY,, C�C�AND ` by%fUN! IP .Y IN
c N WI11) TH
�rite WORT[CONDUCTED.moms=TO
Tao Pitiour,iNamEcTiONS MADE • EIVIIIKENENTS sun ACE OP
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yg CANTO gyp HAR FAILED
D MEAsuRISI TAKEN IIL TO
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i 7[7 E THE ACLU l`Ess DEE t3,EiH' I! ]
MUNICIPALITY.
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THE INDERSIGNID
LICANT,OWIWIR
ANY AND, F AND t.D tI!+yt4 THE ANDl' AVATOR AGREit J NrLy AND SEVERALLY
INDIRSINAt1. LS,A AND Ati, E E AGENTSFROM OR A '1t; M
or ANY
Wi,Ur�?y .D{ tMtA^,S on DAMAGE 1L E'FROM OR 4R1�THIS
APPLI SIGN RE
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