HomeMy WebLinkAboutTrench Permit _BLDT-24-9 - BLDT-24-9 33725Description, Location and Purpose of Proposed Trench
Install a septic system
Dig Safe # (1-888-DIG-SAFE)
20240205634
Name
John Gurka
Street Address
30 Naushon Road
City, State, & Zip
Dennisport, MA 02639
Phone Number
508-398-2116
Massachusetts Hoisting License #
HE-153475
License Expiration Date
03/29/2024
Are you an employer? Select from the options below.
I am an employer with full and/or part time employees.
Insurance Company Name
Rogers and Gray Insurance Agency
Policy # or Self-Ins License #
MAARP301398
Expiration Date
05/10/2024
Type of Insurance Coverage
Liability Policy
Trench Permit
BLDT-24-9
Applicant
CHASE & MERCHANT, INC 508-398-2206 excavation@chaseandmerchant.com
Location
160 WOOD RD
SOUTH YARMOUTH, MA 02664
Trench Information
Excavator Information
Workers' Compensation Insurance Affidavit
Policy and Job Site Information