HomeMy WebLinkAboutBLDTR-23-001161 17?t1.4 e
TOWN OF l'ARA I()Lif FL q_/-02__
/Lk* BUILDING DEPARTMENT Permit Number
1146 Route 28,South Varolouth, NIA. 02664
508-398-2231 ext. 1261 Fax 5118-398.0836 Date Issued
Expiration Date e,614- 135)e-
• s •
ECEIVED
T ' NCH PERMIT
Pursuant to GI. c. 82A §1 and 520 CMR 7. et seq.(as en
AUG 22 2022
nits PERMIT MUST BE FULLY COMPLXITD P tRIO CONSIDERA TION1
BUILDING DEPARTMENT
I Nernst of Appikint 6 itcswe,-t-i 0" tykt.. Phone Cell IbY
Street Address 5Og
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Cityaovm MA
ZIP
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Noma of Erwsvator lit different from appilcant1- _Moms
Street Address
Cityrrown i MA ZIP
Nano oit Outten',et Property_ Phone Ceti
Anthcoi
Street Address
EAPti r‘er,
Ckyfrown MA ZIP
Li 0.f fr 0411
()tiler Contact Permit Fee Received 1441 Yrs
Description.location end purpose of proposed trenths
Please describe the wart IsestioN&the proposed trench mod its •, iinchicht a description of what is ter is intended)to
be laid In prnpesed(recut(es;pipes/cable lines ete-1 nesse use reverie ski*it additional space Is
A 5t,-a\0.A1 0, at 5kfi
insurance t'ertilksis It
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Name sad('entart Informatk,n Ifts-coser
Sele,cktt- titS.
LK% Anon II
Die Solis
of
contr;etert.Pence I as defined by S20(NI*7,e2):
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L. GrKiet 7, Ent •
Y siGNING THIS MEM. APPLICANT,OWNER, AND F.XCAvAroaACKNOWIEDGE C
THAT TIM ARE F AM WITH.on..SKIVES COMMENCEMENT WORK,WILL BECOME FAMILIAR
ALL LAWS AND REGULATICIMICABLE TO WORK ' : 0 • t.: -D.INCLUDING t ' :itzGuLATiow
G.L. e. S2A, 52$ CMR 7.0 d dt$4, AND A C ORIMPIANCES. SY-LAWS AND
REGULATIONS AND THEY covENAza AND AGREE T ALL WORK DONS UNDER THE PERMIT
SUCH WORK WILL COMPLY THEREWITH" ALL ' -.• H TRE caNDITIoNs ,
BELOW.
THE UNDERSIGNED OWNER AUTHORIZESAUTHORIEKS TVA APPLICANTTO APPLY FOR TIIE PERMIT AND
EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF TEM oirez. AND ALSO. FOR
DURATION OF CONSTRUCTION, A <.e . VA-a;. PEESONE Y • . e m; , • BY . MUNI
ENTER UPON THE PROPERTY TO MONITOR AND MIMEO' THE WORK FOR CONFORMITY WM4 Tilt
CONDITIONS ATTACHED HERETO AND TIIE LAWS AND asouLATioNs DOVE SUCH WORK.
THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVESIALLY TO
RECIERIIRML THE MUNICIPALITY FOR ANY AND ALL COSTS INCURREDBY THE
MUNICIPALITY IN CONNECTION WITH THIS PERMIT WORK CONINI +t THEREUNDER,
INCLUDING II T Nor LIMITED U)ENFORCING ;,t , x OF STATE LAW AND CONDITIOE1S C
THIS PE*J rr,IIFSPECTIONS MADE TO ASSURE COMPLIANCE Tiatagwrrit,AND MRASURIIS TAKEN SY
M CR"At.1'I'Y TO PROTECT THE PUBLIC WHERE THE APPLICANT OWNER OR EXCAVATOit a . FAILED
COMPLY unitsisirk DICLUDDIG POLICE DETAILS 1. • ., • *, DEEMED
'NECESSARY BY THE MUNICIPALITY.
tug UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE ' AND SEVERALLY TO DEFEND.
t i :: 1 AJVD HOW RAIDELESS THE MUNICIPALITYALL OF A ' 4 AND : VIBE FROM
ANY LIABILITY,CAUMIS OR ACTION,COSTE AND=leanL FROM OR ARISING OUT
OE ANY INJURY. DEATH, LOSS, Olt DAMAGE TO A ' . e OR PRO t- . r WOES
CONDUCTED UNDER THIS PERMIT.
APPLI SIGN RE
DATE -22 3Z
FXC VATOR IGNATURE(IFDIFFERENT)
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