HomeMy WebLinkAboutBLDT-23-2081 Yam, T - V'VN OF YARMOUTH
\o' BUILDING DEPARTMENT Permit Number f.3L' �0_ Zoe
OI� _ y 1146 Route 28,South Yarmouth, MA 026�i 3
m�n° "� �� 708-398 2231 ext. 1261 Fax 5()8-39)3-0836 Date Issued
Expiration Date
$50.00
TRENCH PERMIT
Pursuant to G.L. e. 82A *1 and 520 CMR 7.00 et seq.(as amended)
nns PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSID
Lett:, ( EdtAATTO�J
Name of.�;ppiicarat ark (Olit t:, ` b 1"�4ive, 10,, Ce,
ark) ,�j � Phorrs Q
Street Address; 4��^-E 9 Furl SL' _ <}3 /
City/Town .(�/ NIA ZIP
Nose of Excavator(if different front applicant)
Phone Cell
Street Address
City/I-own MA ZIP
Name of Owners)of Property • 11
L) Oce-.� L l • n% Pine Cell
Street Address •g) ile.h.-li ( jk Y OS -39 q- 906
City/T a wt1 __ �_�'. NM ZIP `-`— /
Other ontmst
Description,!needn't and Permit Fet Received No ► Yes
Dmid*escr tion,i!n the exact 1u of proposed trench! I C'
location of the proposed trey a its pose(include text1a description of who is(or is intended)to
be paid in proposed trench(eg;pipes/cable limes etc..)Please
use reverse side if additional 9psce Is needed
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N trap sad oC nta t lntor4m tlon of lnaa .
Did sat:4: �U.�13 '3 � __._ _
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Competent Pe a r oad by SIi3 t'S1i8 7.Lt1); -- ___.
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AUG 14 2023
I of 2
BUILDING DEPARTMENT
By:
•
Massachusetts Hoisting Lic nse II /J U 3 7
/1c: 44--/
•
License Grade: c)A- 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. c. SEA, 5211 CMR 7.00 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 TIME PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONIEJRMTTY 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 TITS
MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER,
INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDITIONS OF
THIS PERMIT,INSPECTIONS 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,
INDEMNIFY, AND HOLD HARMLI.R 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.
APPLICANT-SIGMA
DATE //yh--5
EXCAVATOR SIGNATURE(IF DIFFERENT)
DATE
OW ;R'S SIGNATURE I IF DIFFERENT)
DATE: k
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