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Home My WebLink AboutBLDTR-22-007355 _.%` • ' / ai/`-""d._ /Q) TOWN OF YARMOUTH 4 BUILDING DEPARTMENT Permit Number / ��_ p 0-3 1146 Route 28,South Yarmouth,MA 02664 re CTTA Mks ., 508-398-2231 ext. 1261 Fax 508-398-0836 Date Issued Expiration Date $50.00 TRENCH PERMIT Pursuant to G.L. c. 82A §1 and 520 CMR 7.00 et seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant E/<<„o• Phone Cell $oa-G 30-C r i y �icY Street Address/3 7S A -re/lc.,,,d T(,•.,ficge /444c 6 e11-e CT Email Address:C1 !r4/4•r ats'�'.av�-c,yc9G(,ccos City/Town Mk' ZIP - i i c eery e. Name of Excavator(if different from applicant) + Phone Cell Street Address Email Address: City/Town I MA ZIP Name of Ownerls)of Property /,..3Per t Phone Cell Street Address Lj', , Fai•� IQd /Va esi'y Email Address: City/Town MA ZIP Y mo`Y i _ oa 6 7s Other Contact [ Permit Fee Received No(_ 1 Yes( ) Description,location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose(include a description of what is(or is intended)to be laid in proposed trench(es;pipes/cable lines etc..)Please use reverse side if additional space is needed. ZNy rev- e r en-2'. j b -/--•" Reil/f�at (/?also .o u•- . � .,r�-�/1 j ,770,1h.1r ir, S)-•ret Insurance Certificate N: / 3 7Q 3 Q Name and Contact information of insurer: 1i� �tcas Z4 l -$ 7 7 -- ifs ?3 73 Policy Expiration Date: 1 t / / /20 2 z 1 Dis Safe If: a — o Y 8 y II Name of Competent Person las defined by 520 CMR 7.02): S -Feyt tees-, _�-, Name of Competent Person(as defined by 520 CMR 7.02): S±Cphen irOsc Massachusetts Hoisting License# YE" /4 'PIA License Grade: (C Expiration Date: 3/3o/2043 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 WITH 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 SIGNATU DATE 6 421 a.0a A EXCAVATOR SIGNATURE(IF DIFFERENT) DATE 6t?�/.jaa� OWNER'S SIGNATURE (IF DIFFERENT) DATE: '�a "'�„ �S"' .a �`�"�.. -�,` +`� S• - "�. � `G�a F, ' a 1 `��at_,+�9`.��' '�`;`o'"-� �•-' .'a 1 4' ', -yrn.R 1--7 .r�;,4"'�F' ' . i)" y�� ,�,p I .. '- y`y '�'Tip.}�i4'di• x Ts'�:°S�`�.'� ,�r;� ',-S u �.r ,j. , FP {fy e�ca Town of Yarmouth DATE Department of Public Works REW4WED COI -2-3 AktrW ROAD OPENING PERMIT Pursuant to the Town of Yarmouth requtrements and applicable provisions of Massachusetts General Laws,the undersigned respectfully requests that your written consent be given to excavate tuxl/or tunnel under the ground in the following Town/publicipnvate way(s)for the following purposes 3 qa/70 LOCATION: g„.„, Foie0.7 JCL ryth __[or#Joj-icts POLE# 4— PURPOSE: _41407 rev* Paw 1!•-- '44*Proposed depth depth of cut. teet (NOTE:if or deeper cut is proposed,then you may also need to apply for a Trench Permit from the Yarmouth Building Department see more below) The undersigned agrees to conform to all applicable federal, state,and local laws,by-laws,regulations (e.g.,OSHA),and guidelines,and to abide by all stipulations of and attachments to the Permit. In addition,the undersigned agrees by the acceptance of this Peron to be responsible for all acts in connection with this Permit;have appropriate insurance coverage for any injuries to persons or property; indemnify the Town of Yarmouth for any of its acts in connection with this Permit;and, be responsible for trench excavation and maintenance during the period of construction as well as trench repairs caused by settlement and/or poor construction for a period of one year from the date of pro)ect completion. CONTRACTOR. ALL.44:;),0 PHONE: Sifzy •-•6s- ? ADDRESS. t?grit _7-,./r4, CONTACT C.4"'„r- cart /14•,,e4 r IL re P_CE11 IP SIGNATURE PAVEMENT CUTS ALLOWED C " NO INFRARED REQUIRED YES deli SPECIAL CONDMONS/ATTACHMENTS. • Cut sidewalks must be returned to ADA standards --A5bi if3 qtta u) ros5Yekik ( \W 1ldr 5Lirlry 1-f- WAN. • Massachusetts State Law(MGL c.82A s.1 and 520 CMR 7 00 et seq)requires that an excavator obtain a"Trench Permit"from the Town of Yarmouth prior to digging a trench on public or v0( private land or within public or private ways. A "trench"is defined in the regulations as"An excavation,which is narrow in relation to its length,made below the surface of the ground in excess of 3 feet and the depth of which is,in general,greater than the width,but the width of the trench,as measured at the bottom,is no greater than 15 feet." A trench permit application can be obtained at the Building Department located at the Yarmouth Town Offices at 11445 Route 28 in South Yarmouth. • All materials and construction methods shall meet Massachusetts Highway Department's Standard Specifications,as amended herein. • Permittee shall call DIGSAFF and the Yarmouth Water Division(508-771-7921)at least 72 hours prior to initiating any work. • Only one half of the road may be closed at any one time,at least one travel lane shall remain open to traffic flow,and adequate police direction(paid by Permittee)shall be provided. Continued next page 1 of 2 SPECL L,C9NDtTIUNS/ATTACHMENTS(Continued): • Pavement cuts may be allowed only if it is proven that all other alternatives have been exhausted. • Pavement corings of several patches will be taken by the Town. If these corings indicate that the patches do not meet the Town's specifications,then all patches completed by that Utility/Contre+etor/Permittee shall be excavated and properly repaired under the direct supervision of the Town(or its designee)and at the Utility's/Contractor's/Permittees expense.. • The Assistant DPW Director or his designee shall be the only person who can waive any of these requirements, • Every Permittee shall have a signed Agreement and bond on file prior to submitting a permit. • Except for large projects(see next note),all pavement cuts shall be infrared heat treated or milled and overlaid within I year of the final patch installation. • For large projects where the pavement has been cut along a significant length of the road(e.g, trench needed for a utility main replacement),the entire width of the road shall receive an overlay(1"minimum thickness)for the entire length of the cut(or shall be sealed if the Assistant DPW Director determines that an overlay is not warranted). The Assistant DPW Director or his designee shall make the determination of what constitutes a"large project"and what specific overlay or seal specification is required. • Plowable fill(excavatable controlled density fill)is required for the full depth of the trench on all pavement cut areas on any road included on a list maintained by the Yarmouth DPW/Engineering Division. In addition,flowable fill is required on all pavement cut areas if the road has been surfaced or sealed within 5 years prior to the permit application. • Flowable fill may also be required if an emergency pavement cut is needed during cold weather. • In disturbed shoulder areas,loam(4"minimum),lime,fertilize,and seed as necessary, • In paved areas. o saw cut trench/remove pavement from site; excavate/complete utility installation; a compact backfill in 6"lifts to within 12 'ra"of finished grade(unless flowable fill used); o place and compact S ofi"of dense graded crushed stone(unless flowable fill used); 0 place and compact temporary hot patch(maintain patch on daily basis,as needed); C after minimum of 3 months open to traffic,remove temporary patch, o saw cut or grind(mill)pavement; o level off and compact dense graded crushed stone, • sweep area,clean trench of debris,and tack coat pavement edges;place and compact 3"of bituminous binder; o sweep area,clean trench of debris,and tack coat pavement edges and binder surface;place and compact 1"of bituminous top to finished grade, o maintain permanent patch for 6 months and infra-red heat treat(or equal)entire cut immediately thereafter,if required;and, bituminous patch total thickness shall be a minimum of 4"or must match existing pavement thickness if greater than 4". • Construction area shall be swept and all excess materials removed from the site and legally disposed of • Compact backfill in 6"lifts(backfill shall not contain pavement,stones larger than 3",or any other deleterious materials). • Return work area to existing grade and condition with materials that are equal to or better than existing. • Please attach a sketch of the proposed work to this application, 2 of 2 05/13 SAW CUT AND TACO COAT Nu_ DEPTH OF EXISTING t' COMPACTED HOT MIX OR MATCH PAVEMENT, EXISTING PAVEMENT THICKNESS. WHICHEVER ,S GREATER4,444 affoovvotioovriv sT��r� ,..Yr«;ar.,.+�..ar.. ►, Si3EwCMPACTED DENSE ADED :41+01411iii, ii. iria', USHED STONE SUBBASE . 4 w wY SU€TABLE BACKFILL wY w* CQRIPACTED IN S' UFTS ! 3 Y NEW UTIUTY PA T I NOT TO SCALE NOTES: SEE "ROAD OPENING PERMIT" FOR ADDITIONAL DETAILS AND SPECIAL, CONDITIONS 2 IF PAVEMENT THICKNESS EXCEEDS 2 INCHES, THE PAVEMENT MUST BE PLACED IN MULTIPLE LIFTS AND THE SURFACE CLEANED WITH LEAF BLOWER AND RECEIVE ANOTHER TACK COAT, A i A7 m 7 qqk V, X' I i I3xi .1 . 4 a -� t Pay; . , i -;" >8 i 1 ilj r,3 .1 ;a c i fr.;i., i 1,,, It I . 3¢ CYrt fjiiR z3k} P s M a s c= , se f► fii gip; 3 a 1 f/I g a .�.. t' -,,( '' v'tl i t E 1g ,0 8 f h ¢ II �', it 3 1 112 •,*-7 f .