HomeMy WebLinkAboutBLDT-23-2095- TlmwN kw N.k\k v.xxx.
Ea y 1146 Route 28,South Yarmouth, peC1Il1� Number
�"*�;,,�.����� 508-398-2231 ext. 1261 ' ILIA 026� � �'
Fax 508-398-0836 / Z3 ��
Date Issued
1
Expiration Date
Pursuant TRENCH PERMIT $50.00
t to G.L.GL c. 82A §1 and S20 CR7.�mewl.MUST RE FULLY C'OlHPEZED P �et seq,�g,�'�ended)
Name otApplkant PKM Contractors, Inc. �R TO CONSIDERATION
�N
street Addre+r 313 m R
PO• .Hoku Box 775ock
(508)385-5993 / COI
C&y/Towp (508)237-3328
East Dennis NA Zit
MA 02641
Nano of Excavator(it different frosts applicant)
Street Address Phone
Celt
ZIp
Name a D"". is►of Ph'
Street AddressPerms Mark Bailer
315 Union Street
y/Tow�n
South Yarmouth MA Zit
South
OtherContact MA 02664
Description,lop
mid
be i Pos trenchPlease describe ion the pro a ed trench
f eg.pipes/cableNaas eta Please se it lode a r•,_
Pump and remove existing system, install H-10 1,500 add d a
leach chambers -bona fain i Intended)0
gallon septic tank, d-box and(4)500 gallon, H-20
RE�Cnt _ED
P RTM ,T'
SEP 15
ln�sun�t•err;�„te p: ,023 3
VUMA0308030 I V+ and Corps inform: BUILDING et:. f
BUILDING
y Berkley Assurance Co.- don"t trrer, �Y E
PH Bryden$Sullivan-(508)398-6060
Dig le l fir. 04/04/2024
2023-3714382
'Yew of Competent
Patrick rat rie/f
K. McDowell ned h,320(AIR 7.021:
1 of
TOWN OF YARMOUTH
'P BUILDING DEPARTMENT Permit Number 3LD%-Z3 -Z9
-
ol i`� ki 1146 Route 28,South Yarmouth, NIA 02664
[It 4" 508-398-2231 ext. 1261 Fax 508-398-0836 Date Issued
• .'J p}tl•�r�leS
Expiration Date
$50.00
TRENCH PERMIT
Pursuant to G.L. c. 82A 11 and 520 CMR 7.00 et seq.(as amended)
THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION
Naart of Applicant PKM Contractors, Inc. Phone Cell
Street % ire 313 Hokum Rock (508)385-5993 / (508)237-3328
P.O. Box 775
City/Town MA ZIP
East Dennis MA 02641
Name of Excavator(it different front applicant) Phone Cell
Street Address
City/Town MA ZIP
Nanne at Owneris►of Property Mark Bailer Phone Cell
Street Address 315 Union Street
Cky/Town MA ZIP
South Yarmouth MA 02664
Other Contact L Permit Fee Received No ) Ye( ?
Description.&Deaden and purpose of proposed trench:
Please describe the exact location of the proposed trench acid its purpose(include a descripdoa of what is(or is intended)to
be laid in proposed trench Kg;pipes/cable Hats etc-)Mean use reverse side if additional space Is needed.
Pump and remove existing system, install H-10 1,500 gallon septic tank, d-box and (4)500 gallon, H-20
leach chambers
[RECEIVED
I SEP 15 2023
A2,
BUILDING EHkRTM T'
Iracerrance t'trtdkate : 6y
VUMA0308030
Name and Contact InformsiMn of Insurer:
Berkley Assurance Co.-Bryden&Sullivan-(508)398-6060
Pulky Expiration Mee 04/04/2024
Dig Safe p 2023-3714382
i Nance of Competent Person(as defined by 5211 CMS/.412):
f Patrick K. McDowell
i of pi61(\ 0\\\(1c,,v)-6
Massachusetts Hoisting License I HE 039080
License Grades HE2A 04/19/2024
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 WORE, WILL BECOME FAMILIAR
WITH,ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS.
G.L. c. VIA, 520 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 TILE CONDITIONS SET FORTH
BELOW.
THE UNDERSIGNED OWNER AUTHORIZES TILE 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 UNTIED 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 HOW 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.
APPLIANT SIGNATURE
' / DATE 9/15/23
EXCAVATOR SIGNATURE(IF DIFFERENT)
DATE
OWNER'S SIGNATURE OF DIFFERENT)
UC it, DATE: 9/15/23
Far(balms -Ile art wile k t
$Bg Apreatise Ise
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