HomeMy WebLinkAboutBLDTR-23-003196 TOWN OF YARNIOUTI-I
BUILDING DEPARTMENT Permit Number 6a)77z --
-.1 1146 Route 28,South Yarmouth, MA 02664
508-398-2231 ext. 1261 Fax 508-398-0836 Date Issued _ 603i 9 fr
Expiration Date 0,Y.,-tt )3/0 /Es'
$S. .
TRENCH PERMIT
Pursuant to Qt.e. 82A II and 520 CNIR 7.00 et seq.(as amended)
THIS rutairr MIST BE FULLY COMPLETED PRIOR TO CONSIDERArtoN
Menu of Applicant b 3 6 itumw+i,34.,, tyv„, Phone Cell
%melt Address 5 O 8. 411 ot3
'S-441 g..int4-. r144'
City/Tows MA 11UP
Nsess of Excavator tit different Dora spplktnitt Phone C1j
Street Ackirtat
City/Town MA I Zip
- -
Nearest ot Owneroo or Property gdot‘k, vt ut(mac) phone " cal
Strad Address
23° (1)4610V) 6 rkk eot
City/Town .i MA I ZIP
'la(ilibu 1-1,
()oar contact ' I Permit Fee Reedited No t ) Yet f. )
Doseription.Woad.*and porpox at prepoled trench:
Moose**tribe the coot fixation tithe proposed trench and its pennant°winds a description sof whet ts(or 1 intended)te
1*toed to proposed trench tee;pipsokshie floes ete.)Pleas/use reverse side if sdiditionsi spats is * ,
1451-taakir Oi SleC .014SA-ki'N (+OA' Or\ktt)
RECEIVED
DEC 08 20,1
insuttsnee Certilksbt lb " I PAR ithNT
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Na..sad Contort fottwoution of fitsunin
SAtc)64, tAS.,
Policy Espitsdon Doc $1
Dig Seta 1101
Z.02v-1(16 iqqz
1 Name of Comment Perna two defined by 5211 CMS 7.02n
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MF*Tasechuseets Heisting LiCeilirr 0 11'0
2,4
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patBta
ay siGNINGTICPAM,TILE AprucANT, OWNER, EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY
111AT THEY ARE FAMILIAR WMI.o . :e $SE CO a CEMENT OF THE WORK.WELL BECOME FAMILIAR
ALL LAWS AND REGULA a CABLE 10 WORK PROPOSED. I 1 a OSHA REGu LATIN'!NS,
G.1.. C. 52B CMR 7.ft et .NY CABLE MUNICIPALORDINANCES, BY-LAWSAND
gEGLIATAms AND THEY COVENANT AND AG' .3 THAT ALL WORE DONE u : .Iti THE FERNITT ISSUED FOR
SUCH WORK WILL COMPLY T CONDITIONS SET FORTH
BELOW.
THE UN1 IGNED OWNEE AUTHO° TO Y FIDE . PEWIT AND THE
EXCAVATOR TT) UNDERTAKE sties WORE ON PRO OF OVINE*, AND ALSO. FOIE THE
DURATION OF cor mRt N, Ao'rt A is. NS DULY ':...,.t , _ , BY THE SWINICIPALFTY 11.1
ENTER umm •- TO MONTTOR INspecr I WORK FOR CON'FORMITY WITH THE
CONDMONS ATTACHED 't D THE LAWN AND IIIGULA .a140 COVERING SUCH WO
TIM CND IGNED APPLICAaff,OWNER AND EXCAVATok AGREE JOINTLY ALLY TO
C ;. THE MUNICIPALITY FOR ANY AND ALL COSTS AND -+.i - . •. IN ,;a SY ma
AUPOCIPALM IN CONNECTION i-tos rr A THE WORK C N
INC1.UDING suT Nth'LIMITED ENFORCING • . OS"STATE LAWAD CONDITIONS
OF
PERMIT, e" ,"" ; +NB MADE C a_r k 'rat' : '- MEANS=TAXES SY THE
mumeIPAI.ITY TO ° `%i CT THE I.1.1C WHERE INK A C OW144EIR Olt EXCAVATOR HAS FAILED TO
COMPLY THERZW11111 INCLUDING CS AILS AND MEDIAL . DEEMED
NECESSARY BY THE MUNICIPALITY.
THE UNDERSIGNED CANT,OWNER AND IXCAVATORAG';,t . ,1 a.'. ; Y AND ` I I.Y TO DEFEND,
INDEMNIFY, AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF A !N'I"B AND EMPLOY FROM
ANY ALL.LIABPLITY,CAC.!'t , Acne)), AND •h$- SES RESULTINGM OR ARISING
OUT
OF ANY TKOTRY. DEATH, 1 On DAMAGgTO ANY PE # DUNG THE WORE
Coo DUCTED UNOnn THIN P '
APPU, T SIGN RR
EXCAVATOR IGNATIJRE t RDIFFE
DATE
C)i tNI;R'S SIGNATURE i IF DIFFERENT)
rte.tibirroallet—60110 wit*,
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