HomeMy WebLinkAboutTrench Permit _BLDT-24-10 - BLDT-24-10 33827Description, Location and Purpose of Proposed Trench
septic system installation
Dig Safe # (1-888-DIG-SAFE)
20233408141
Name
Laurence F Ellis Jr
Street Address
8 Street North Street
City, State, & Zip
Dennisport, ma 02639
Phone Number
308-362-6237
Massachusetts Hoisting License #
HE-028673
License Expiration Date
12/30/2024
Are you an employer? Select from the options below.
I am an employer with full and/or part time employees.
Insurance Company Name
West American Insurance Co
Policy # or Self-Ins License #
BKW58371201
Expiration Date
03/01/2024
Type of Insurance Coverage
Liability Policy
Trench Permit
BLDT-24-10
Applicant
Laurence Ellis - Ellis Brother's Constr
uction
508-362-6237 ellisbrothers@comcast.net
Location
48 WILLIAMS RD
WEST YARMOUTH, MA 02673
Trench Information
Excavator Information
Workers' Compensation Insurance Affidavit
Policy and Job Site Information