HomeMy WebLinkAboutBLDT-23-2069 (2) TOWN OF YARMOUTH
Tak
S BUILDING DEPARTMENT Permit Number 3 7 Z3 - et 04
( y 1146 Route 28,South Yarmouth,MA 02664
ti ten_i .Ett 508-398-2231 ext. 1261 Fax 508-398-0836 Date Issued
_ C V E D 1 Expiration Date
JUL
14 2 023 $50.00
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TRENCH PERMIT
'3vILLri(Vf )rF=r k 1 Ibii-NT
c.S2A I1 and 520 CMR 7.00 et seq.(as amended)
THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION
Name of Applicant PKM Contractors,Inc. Phone(508)385-5993 Col;(508)237-3328
Street Address 313 Hokum Rock Road
P.O.Box 775
Cityftowa MA ZIP
East Dennis MA 02641
New*of Exrsrstor tifdiffereat Prone applicant) Phone Ceti
Street Address
CitylTown MA ZIP
Mum of Ow of of Ppsch Barbara Sutherland Plant(508)398-3451 flit
}
Street Address 757 Willow Street
Cityftown AMA ZIP
South Yarmouth MA 02664
other!Contact I Permit Fee Not ) Yes( )
INISCripifinte location and purport of prIntend trench:
Please describe the exact location a(the proposed trench and its purpose(Inelde a description of what is(or is intended)to
be laid In proposed trench(es;pipedeabk oats etc..)Please use reverse side if addltional space sanded"
Pump and fill existing septic system.Install(2)new,1,500-gallon,H-10 septic tanks.(1)DB3 distribution box.Over-dig for leach
field and install 20'x 30'leach field with 4"perf PVC pipe.
insurance Certificate p0 VUMA0308030 {{
` 1
Name and Contact Inforinstimt of insurer:
Bryden&Sullivan-485 Route 134,South Dennis,MA 02660
Pia"Ftpiration Date: 04/24/2024
Dii Sate P: 20232515395
`tame of Competent Purses tas defined by$20('MR 7.02)s
Patrick K.McDowell
/9 DM P iC A.Av . n.es-
of 2
!sue
Minseschusetts Hoisting License I HE-039080
•
License Grades HE-2A
Rspirsdop Date: 04/19/2024
BY SWAYING THIS FORM, THE APPLICANT,OWNER,AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY
THAT THEY ARE FAMILIAR WTIx OR,BEFORE COMMENCEMENT OF THE WORK,WILL
WITH.ALL LAWS AND REGULATION APPLICABLE TO WORK PROPOSED, BECOME FAMILIAR
G.L. c. SA. S211 CMR 7.00 d 'eq., AND ANY APPLICABLE MUNICIPAL ORDDIAN
REGULATIONS AND THEY COVENANT AND AGREE THAT ALL WORK DONE UNDER THEM BY-LAWS FOR
SUCH WORT[ WILL COMPLY THEREWITH IN ALL RESPECTS AND WITHPERMIT ISSUED
BELOW, THE CONDITTONS SET FORTH
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 CONTRUCTLON; AUTHORS P 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.
TREIMBURSE HE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO
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 RE'000TEMENTS Of STATE LAW AND CONDITIONS OF
THIS PERMIT,INSPECTS MADE TO ASSURE COMPLIANCE THEREWITH.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,
1ANY AND ALL NDEMNIFY,AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS AND EMPLOYERS FROM
OF ANY INJURY. CAUSES
OR DAMAGEANY PERSONOR ARISING cons,AND EXPENSES RESULTING FROM OR OUT
CONDUCTED UNDER THIS PERMIT. DURING THE WORK
APPLE T SIGNATURE
//Q(414-� , DATE June 28,2023
EXCAVATOR SIGNATURE(IF DIFFERENT)
DATE
OWNER'S SIGNATURE(IF DIFFERENT)
y'7 5'u2r .4, %u e.
DATE:
Fes,4.
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