HomeMy WebLinkAboutBLDT-23-2089- (fir,-//-e-- C'E3k'<'�va�'7rorq , i—Ac,f
.0 � TOWN OF YA ODTH
. , BUILDING DEPARTMENT A TMENT Permit Number /3Z-07- 73 - 2 9
6.1 ty' 1146 kc►ute 28,Smith Yarmouth. MA 02664
' yew x „ ,�%' 508-398.2231 ext. 1261 C►x 508-398.08.16 Issued
Expiration Date
$5OOO 00
TRENCH PERMIT
Pursuant to C.L.r. $2A 11 and 520 CMR 7.00 et seq.(as amended) .
rins PE IIT MUST liE FULLY COMP. I)P111011 TO Ct7NSP)EkAI1ON'
Nseeew air Applicant b 1 '6 rt4.0,404 a tt :. nem ( iJ
Strom Addrcis 568' 411.0�;;3
City/Town MA ZIP
So,n&W,(N, I+trr., a 2S4
-Neroof Excavator tit different a rased P` Ceil
y
r
Street Address
CitylTown MA --
Neese of Ownert.)of Property phone Cell
Street Address
It° Rose, d
City/Tillage City/Tillage MA I ZIP ....,
S. I a c mo t..111,
Other Contact I permit Fes i eiaed Na tr). Ye.t 1
Deocription,laced.*sad purpose of proposed t
Please describe the exact location artist proposed d trench sad its pawpaw finch**a descriptions at what Ii for to intended)to
be Reid its proposed french(ad:pipet/table lints tee.)Pies..use reverse side it adder'parr la steeled«
1151-tattaki or Ot rr#-►(- - RECEIVED
rw T/ 9yy
G 2 8 2023
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BUILDING DEPARTMENT
BY
trrewanca Certificate pc
Nam**snd Contsrt lni"orn..tion or lalsonen
Se,k cz titS.
Adis?.i.epirrtion then $ ; tr "
11/01,3310 5911
i Nom of C:wnpettrrN Penesl as defined by SIO(MR 7.62ot
l of
Nisesseitusetts Hoisting Lions*. Hf- Ott Sl`$0
• 2.(111 2,4
" Listens Cosies Z .
BY SIGNING TH$Fq►REtl, THE APPLICANT,OWNER,AND RXCAVATOR ALL ACENOWLIDGE AND CERTIFY
THAT THEY ARE FAMILIAR WTTt1,Ott, RE CO E 14 Of IEEE WORE,WILL 011C01412 Fa*1IL,IAt[
WTTII ALL LAWS AND REGULATIONS APTLICAII E TO WORE PROPOSED,INCLUDING.OSHA REGULA IOPH,
G.I.. e. aru, STS cm* 7.4111 a sec, AND ANY APPIJCABLE MUNICIPAL ORDINM4CES, Sir-uWS AND
IIEGULATIOPII AND THEY COVENANT AND AG TEAT ALL WORK DONE UNDER THE IT ISSUED I0>R
SUCH WORK WILL COMPLY THEREWTni IN ALL RESPECTS AND Yffill THE OCtriDITIOiNS SET FORTH
BELOW.
THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE
EXCAVATOR TO UPNDER'TAEE SUCH WORE ON THE PROPERTY OF TIM OWNER, AND ALSO, 11'OR THE
DURATION OfIt CO2 SUL/L-1E1N, AUTHolisZts PERSONS DULY APPOINTED EY THE MUNICIPALITY TO
ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WTTA THE
COVID ITONS ATTACH HERETO AND THE LAWSAND E,EGELAirit3MCOVERING SUCH WORK.
THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGRKE JOINTLY AND SEVERALLY TO
REIMEI RSE THE MUN1 CIPALITY 101E ANY AND ALL COSTS AND +'+ '4 INCUR ItT THE
MUNICIPALITY Y IN CONNECTION WITH 111111 PIrItMI'I"AND TAE WORK CONI UCTED THEREUNDER,
INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE LAW AND CONDTTiONS of
. pinemit,BERECTIONS MADE TO ASSURIL COMPLIANCE THEREWITH,AND MEASURES TAtIN BY THE
MUNICIPALITY To PROTECT PUBLIC WHERE Tim APPLICANT OWNER OR ExCAVATOR HAS FAILED TO
COMPLY I IIERE''iY't'TIJ INCLUDING POUC'DETAILS AND ottrAit REMEDIALy ,> DEEMED
NECESSARY BY nts MUNICIPALITY.
'Ilia UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND,
INJE INIEY,APO HOLD HARMLESSTHE MUNICIPALITY AND ALL OF ITS AGENTSAND EMP'U}Y nRIM
ANY AND ALL LIABILITY,CAUSES OR ACTION,COSTS,AND EXPENSES RESULTING PROM on AEG OUT
or ANY INJURY, DEATH, LOSS, 1* DAMAGE TO ANY EIERSON OR DURING THE WORE
CONDUCE UNDER THIS PERMIT,
APPLI SIG RE
DATE B 28 23
EXC VATOR IGNATVRE<IF DIFFERENT)
DATE
OWNER'S SIGNATURE(IF DIFFERENT/
DATE.__
Ii. tl
Pit
�71.
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