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HomeMy WebLinkAboutBLDTR-23-003319 C (6) )2)1 Li 1 Z2. ov.Ydi TOWN OF YARMOUTH Building Department BUILDING , ;c 4 es (508) 398-2231 ext.1261 0�'",. _ , - PERMIT NO :BLDTR-23-003319 of PERMIT \Mt . ISSUE DATE 12/14/2022 JOB WEATHER CARD stp APPLICANT :St ephen Rose PERMIT TO ,,. ..................... ....., AT(LOCATION) 95 POMPANO RD YARMOUTH MA 02675 ZONING DISTRICT Bldg.Type: SUBDIVISION MAP BLOCK LOT 135.17 r BUILDING IS TO BE: CONST TYPE USE GROUP ; REMARKS Trench-replace underground electric for Eversourc e in front of transformers I ' CONTRACTOR and test hole existing utilities off side of roadway 3 x 5 holes—(774-451-1400) 1 i LICENSE w.T..< *** No pavement cuts allowed per Town Engineer 12/13/22 i AREA SQ FT 531301 320 $) PERMIT FEE( ) , R EST COST( ($) 50.00 OWNER KOZIK MARY O'CONNELL BUILDING DEPT BY ADDRESS KOZIK KATHERINE&SARAH 43 MOHAWK D ACTON MA 101720 PHONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE SEPARATE CONSTRUCTION WORK: 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL PERMITS ARE REQUIRED FOR FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE.WHERE ELECTRICAL PLUMBING/GAS MEMBERS(READY FOR LATH OR FINISH COVERING) A CERTIFICATE OF OCCUPANCY IS AND MECHANICAL 3)FINAL INSPECTION BEFORE OCCUPANCY 4) REQUIRED,SUCH BUILDING SHALL NOT BE INSTALLATIONS. REFER TO DETAILED INSPECTION SCHEDULE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS OTHER: WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION AROVF e ty)al 1 Per nu -' ,pF YAR \ TOWN OF YARMOUTH BUILDING DEPARTMENT Permit Number C?) -- .4 ,�3'`f,ir.. C ' 1146 Route 28,South Yarmouth,MA 02664 / \? MATTAi, "* 508-398-2231 ext. 1261 Fax 508-398-0836 Date Issued e) 3.d 3 I I Expiration Date - .r f a 3D $50.00 TRENCH PERMIT ` "N ' D Pursuant to G.L. c.82A §1 and 520 CMR 7.00 et seq.(as amended DEC 0 92012 THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION; (..._._..______ __- 9UILDING DEPARTMENT Name of Applicant Phone Cell Street Address Mc li TO N\U.A Tp Email Address: City/Town MA ZIP P A e f tR CI O (® ila . firifL, (ofI ede-(fr - ei Name of Excavator(if different from applicant) Phone Cell Cell Street A ress , v rill al t reiiL 9 - /6"&proit, eel V}V-'( Email Address: City/1'own / MA ZIP r)-),.(77s- Yfl il P01t Nam of Ownerls)of Property Phone cep Street Address iftR( 0 u t i Email Address: City/Town MA ZIP Other Contact l Permit Fee Received No( 1 Yes( 1 Description,location and purpose of proposed trench: q 6- ileiVi,/itil 1' _ Please describe the exact location of the proposed trench and its purpose(include a description of what is(or is intended)to be laid in proposed trench(eg;pipes/cable lines etc..)Please use reverse side if additional space is needed. TM PA 0&if 0VRANt'TORf(RI A NCi 111- A0) ( EK IC l'tN Of i I 1 t i el o y-c si, t O 1 4'0 r way -� s T6 f r l u a+r d t K tau( I'll c tR,c � f ams`o vwc insurance Certificate 0: c +a (83 a Li n pa , i� :Van*and Contact Information of Insurer: "\` \ , 1 g \ 5 b IRS Ll.)A+'I6IV Policy Expiration Date: Dig Safe I: ab aAv L1 r Ak\ Name of Competent Person las defined by 520 C'�1R 7.02): , Sk C 0\DO I<D51 _C,, Name of Competent Person(as defined by 520 CMR 7.02): Hof{ Massachusetts Hoisting License# HE — i a .L` i3CIR 3 License Grade: C a‘73 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 WORK,WILL BECOME FAMILIAR WITH,ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS, G.L. c. 82A, 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 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 WTTH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS GOVERING 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 LIMITED 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 SIGNATURE y✓ v,7,2c DATE 1 EXCAVATOR SIGNATURE(IF DIFFERENT) DATE OWNER'S SIGNATURE(IF DIFFERENT) DATE: ...�'+,. '? 'x "'''�yTr-� -x�"�w.h.:v-" `y�'�"xs{ ski�'^.? a 3ni'r"AY`'y�°y+.i. • n4. v{fie 's'', -tY`"� e .�' �3,n'+�.a_.n'.�4.^.c` ima°' _,�.ya y3`_i:,_E+,Q.i.,a.c.Tay;r x�yKy"�.lx.iLiyi.�,&a.5jte.�m.1ar:',.3...st""�.trq�?�''�.p"1.",a+wt.�-'G J•-#.`-.�'�i,-Sa.i a'�,r'r.amo�,t s.�1�zv�."a.^�+gc,..���=q=y-,,`s._' arlaLr-�v+..,,v..�c_v+�..'..�,..;y.,,F.-``x,���a�"r"te1r.'.'c"Q-u` r�a,.��.'.�J�_- z "`i. �k V � �a � 9 � W-=ka,.i+t,1.f4 x+ i a,'a S �=.. ' Page 1 of 1 ACQ 0 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/05/2022 4.r.....--,. ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER'"'-'-.__ CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOR-E- -- - _ BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE`; ---- - REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED pvc-' - - - -- - - - --- If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endcr::::::::- ` _` ----'- - this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER -- CONTACT WillisTowers Watson Certificate Center NAME: Willis Towers Watson Northeast, Inc. PHONE FAX No 1-877-945-7378 A/C _ , 1-888-467-2378 c/o 26 Century Blvd E(A/C�No, ms:— ( )� E-MAIL P.O. Box 305191 ADDRESS: certificates willis.com Nashville, TN 372305191 USA INSURERS)AFFORDING COVERAGE NAIC S INSURER A: Travelers Indemnity Company 25658 INSURED INSURER B: Travelers Property Casualty Company of Ame 25674 Elecnor Hawkeye, LLC 100 Marcus Boulevard, Suite 1 INSURER C: The Charter Oak Fire Insurance Company 25615 , Hauppauge, NY 11788 INSURER D: INSURER E: -_ INSURER F: COVERAGES CERTIFICATE NUMBER:W26832479 REVISION NUMBER: it _ t THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED::= ^= T' - ___-_ INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT':_:-"' -_-_-.. .._-._- CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN E3 -. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP I LIMITS LTR TYPE OF INSURANCE INSD I WV0. POLICY NUMBER (MM/DD/YYYY)JMM/DD/YYYYyl _.._ _; XI COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 3,000,0001 DAMAGE TO RENTED 300,000'. I i CLAIMS-MADE I X I OCCUR 1 PREMISES(Ea occurrence) $ A !: MED EXP(Any one person) $ 10,000 Y VTC2K-CO-5G429112-IND-22 11/01/2022 11/01/2023'' PERSONAL&ADV INJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6,000,000 !POLICY X PRO LOC PRODUCTS-COMP/OP AGG $ 6,000,000 JECT , $ OTHER: AUTOMOBILE LIABILITY (Ea aBI EDtj SINGLE LIMIT $ 2,000,000' X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED VTC2J-CAP-5G429124-TIL-22 11/01/2022 11/01/2023 BODILY INJURY(Per accident) $ i AUTOS ONLY AUTOS PROPERTY DAMAGE T HIRED NON-OWNED $ Included AUTOS ONLY AUTOS ONLY ! (Per accident) $ X( UMBRELLA LIAB X I OCCUR iEACH OCCURRENCE $ 5,000,000 B — EXCESS LIAB CUP_2P677468-22-25 11/01I2022 11/01/2023 CLAIMS-MADE AGGREGATE $ 5,000,000 r1 DED L RETENTION$ _ PER OTH $ WORKERS COMPENSATION I X STATUTE I ER AND EMPLOYERS'LIABILITY Y/N ( 2,000,000 C ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? No N/A UB-0L331819-22-25-D 11/01/2022 11/01/2023 2,000,000 (Mandatory in NH) I E.L.DISEASE-EA EMPLOYEE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS below - --- - — DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) I Re: Permit application The Certificate Holder is included as an Additional Insured with respects to General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Yarmouth Port AUTHORIZED REPRESENTATIVE Yarmouth Town Hall 1146 Route 28 ��4 South Yarmouth, MA 02664 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 23397447 BATCH: 2761962 Hoisting Engineer Restricted to: HE-1C-Telescoping Booms w/o Cables HE-2B-Front End Loader/Backhoes DIG SAFE Call Center:(888)344-7233 In case of accident 81444 Contact OPSI:(fill)727�200 or visitcall: www.(508) 20-mass.gov/dpl/opsi Commonwealth of Massachusetts Dwision of Occupational t..CenSilr. iglettli'rer E 128442• spires:03/30/2023 HSTEPHEN ROSE 306 WiNTROP STREET P220 TAUNTON MA;02780 fi Commissioner • + t 3 0 s E 0 x + 0 Ln 'O CC N N 0 co cn A N a cy C 2 N Q a Cr+ co0) G. m co U X O M in M O N CO VJ L) as cc cry �i co N e o co o G C7 do 0 _ <a 0 E co F h co E c cis E.' O M coCDCii v ii X Cr) . m = O -o To c; a' aY cj t.1 to CO O O N O od o N N , C" 'L^ G1) V i d a C Aa C+ a CO C It +C N ID m N I Pa CC P j�eska`1 CC i ce n (I) Ra ) Q �,bs°ay m E CO d, E 0 U (Li SWG> rn ¢ °o N N ?, O ?1 N a N Clarke, Kristin From: Lima,Amanda Sent: Tuesday, December 13, 2022 1:57 PM To: Clarke, Kristin Subject: FW: Re: Hi, Steve says below that he can stay out of the roadway. DPW would be okay with that condition. DPW would like to review any trenches that have pavement cuts.We will check it against our roadway list. Thanks! Amanda Amanda Lima, P.E. Town of Yarmouth DPW-Town Engineer 74 Town Brook Road West Yarmouth, MA 02673 Office (508)398-2231 Ext. 1253 -ALima@yarmouth.ma.us From: STEVE ROSE Sent:Tuesday, December 13, 2022 11:38 AM To: Lima, Amanda Cc: Clarke, Kristin; Creech, Bridget Subject: Re: Attention!:This email originates outside of the organization. Do not open attachments or click links unless you are sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure. Otherwise delete this email. Yes, I will. On Tue, Dec 13, 2022, 11:25 AM Lima, Amanda <Alima@yarmouth.ma.us>wrote: Hi Steve, all those roads you requested a trench permit for have been recently chipsealed in 2021 and are under a pavement moratorium until July 2026. No pavement cuts would be allowed. Can you keep your work off the roadway? Thanks Amanda Amanda Lima, P.E. Yarmouth DPW-Town Engineer Office (508)398-2231 Ext. 1253 -ALima@yarmouth.ma.us 1 From: STEVE ROSE <steve.rose@elecnorhawkeyellc.com> Sent:Tuesday, December 13, 2022 8:53 AM To: Lima, Amanda <Alima@yarmouth.ma.us> Subject: Attention!:This email originates outside of the organization. Do not open attachments or click links unless you are sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure. Otherwise delete this email. Hi were replacing primary electric cable. Not services to the houses. Need to cut blacktop on Jibstay 3'by 5" Mostly be in the easement in the dirt Thank you 2