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HomeMy WebLinkAboutBLDTR-23-001775 TOWN OF YAR1` ()UTF-I 4,'© o BUILDING DEPARTMENT Permit Number 13 -Z3- q� y 1146 Route 28,South Yarmouth. MA 02664 ',1,. `' 508-398-2231 ext. [261 Fax 508-398-t183ti Date Issued b b E• xpiration Date CK, /3575 D TRENCH PERMIT F E I V E Pursuant to G.L. c. 82A II and 520 CMR 7. et seq.(as ante )OCT 0 3 2022 CRCs PEIRMTi NILS?BE FULLY COM r ED PRIOR TO CtN SIDERA !> PING DEPARTMENT r. Vane . pplkant a 6 itc,N ii po linl• Cell By _ St► et Adclrrw 5d g 41] -cabs'3 _ \ Ramk140 City/Town MA ZIP So.nat4 Mo,- _ 2 5L 3 -Nelms of Eacarstor tit different how Rppdcarttl Phone r Street Address City Town MA UP' Name of(honest.)of Property II,bro. (d,(iPa. V cell Street Address c oJStt o nn 33 N04e11-iCc Lome- Ckerawn MA I ZIP 10.i(Nall Other Contact 1 Permit Frr Rereired No O Yen Description,location and purpc oc of proposed tronc►t Please describe the exact oration of the pro trench and its • - . (include a descriptions of what is(or is intended)to be Laid Its proposed trench es t Ira;pipes/cable Ho etc..)Please use reverse!yids it additional'pace is needed. I�ns1-at\&ki Qr jt rosette no Certificate Or S25agi24 !Isar sad Contact Information of laserer _ _ _ Policy Expiration!)ate: , 2.017,3(0q/S6-1 i !lame of Competent Prrwa t as defined by SID t.Ma 7.02): ! of 2 ing Lkvtoss Ip - o v i License Credal Y- Z ti ltit Ex.`r tii Y SIGNING THIS FORM, THE APPUCAN ',OWNER,AND EICCAvATas ALL ACKNOWLEDGE AND army THAT THEY ARE VANILLAS WTTII,0R,BESTIRS CO s ►-4 ». Of THEWORK,WILL BECOME FAMILIAR ALL LAWS AND REGULATIONI APPLICABLE TO G.L. VA, CMR to. tt „,, Al' W ► ' #' D, RR-LAWS N REGULATIONSAND THEY COVENANT AND AGREE WO ' C)R t nits E PERMIT S WR AND i WORK WILL COMPLY Tl� IN UNS " I tJBI?FORTH LOW. "" ` . ► CONDITIONS SH'I' 1C3RI"R THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WOFZ ON THE I24 1 O AND ALSO, FOR DUILATION Of CONITRUC N, AtTTFIC 4` ayTHE ENTER N THEMOOR AND Y t woss vas. ,<t r : 14�y "AITH TOE CONDITION!ATTACHED HERETO AND THE LAWS AND REGULATIONS COVERING SUCH � WITH THE EMSJGNED APPLICANT,O AND EXCAVATOR AGUE JOINTLY AND SEVERALLY TO REDNIURSE THEE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPEKSZLI INCLIRRED RY TUE MUNICIPALITY IN CYtNNECT1ON PATH THIS PERMIT AND THE WORK CONDE1 INCLUDING RUT Nor Ttt SNIT:1 ;r * . .1 x * TIIM comae INSPECTIONS TO ANAEMIC•, t' STATE ME*LAW AND 1�1KEN BY mumnpALITHIS TY TO net THE PUIILIC WHERE � TAKEN COMPLY THEREWITH INCLUDING C t) R OR EXCAVATOR FAILED Y ay MUNICIPALITY. If d THE UNDERS1 N+tED APPLICANT,OWNER AND EXCAVATOR AGREE Joarnivr AND SEVE ovEMMIJ"Y, AND HOLD HARM THEMUNICIPALIT' ALL A RALLYTO DEFEND, ANY AND ALL LIABILITY,CAUSES OR A EXPENSESAND �` ? ANY INJURY, DEATH, DAMAGE TO ANY R JL M OR A Gog& t OO UND TT. ,r WC7litlt APPLI • T SIG RE DA TE i d• 3- ZL EXC :VATORSIGNATURE ILE D 7 / to OWNER'S SIGNATURE i IF DIFFERENT) ....�.,�......-- ...... DATE. it,. lrawr i� 2 of