HomeMy WebLinkAboutBLDT-23-2090- TOWN OF YARMOUTH
YaRt. 46 BUILDING DEPARTMENT Permit Number &/)7- Z3-4)96
1y y 1146 Route 28,South Yarmouth. MA 02664
,fir. 508-398-2231 ext. 1261 Fax 508-398-0836 Date Issued
<•4p.tt6
Expiration Date
$50.00
TRENCH PERMIT RECEIVED
Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as am (frd)
ruts PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERA N AUG 2 8 2023
None ofAppliesnt PKM Contractors, Inc. Phone Cell BUILDING UEPARTINA?7,1T
Street Address 313 Hokum Rock Road (508)385-5993 / (508)237- 3 8
P.O. Box 775
City/Town MA ZIP
East Dennis MA 02641 * PKM@p .net
Nina*of Excavator(it different from applicant) Phous 4-dt I¢ "� r
4.,
Street Addy** AUK 8
2023
City/Town MA ZIP g D�CDING DEPgRTMF
N
Nsm5 of thmerts)of Property Andrew Gallagher Phone Cell
(508)753-8180
Serest Address 50 Neptune Lane
Cky/Town MA I ZIP
South Yarmouth MA J 02664
Other Contact 1 Permit Fee Received Nut ) Yes( )
Description,location and purpose of proposed trench:
Please describe the exact location of the proposed trench sad ib purpose(Include a description of wind is(or is intended)to
be laid in proposed trench(ea:pipes cable lines etc-)Please use reverse ride if additional space Is needed.
Excavate for new addition. Install 2,000-gallon septic tank/pump combo, simplex pump system. Install
12'x 38'raised leach system and breakout wall.
Inaursnce Cereifkate eI VUMA0308030
Name and Contact information of Insurer
3 Berkley Assurance Co.-Bryden&Sullivan-(508)398-6060
Polley Expiration natr. 04/04/2023 R_.
Dili Safe Ft 20233501796
Name of Competent Person t as defined by 52011 Mit 7.02):
Patrick K. McDowell
I oft
Massachusetts Hoisting License I HE-039080
.
• UMW Grades HE-2A E:piration Date, 04/19/2024
•
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 a STA, 521 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 THE PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY 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 THE
MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER,
INCLUDING BUT NOT LIMTTLD 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 HARMLESS 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 )�ySIGNATURE
irDt - DATE 12-51 2 3
EXCAVATOR SIGNATURE(IF DIFFERENT)
DATE
OWNER'S SIGNATURE(IF DIFFERENT)
,cQ tiA w- C a.fa _DATE: 0!/2S/2a23
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