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Home My WebLink AboutBuilding PermitsFRIEDLINE & CARTER ADJUSTMENT, INC. 436 Main Strcct, P. O. Box 338 Hy-winis, Massachusctts 02601 Tel. (508) 771-3232 FAX (508) 790-2344 TO: (Building Commissioner or Inspector of Buildings () Board of Health or Board of Selectmen ( ) Fire Department TOWN OF YARMOUTH TOWN HALL YARMOUTH, MA RE: Insured: BAKER, Curt E. Property Address: 33 Hatch Street South Yarmouth, MA 02664 Policy Number: 10457771 Type of Loss: Ice Dam Date of Loss: 3/28/2015 File #: 122646 R E 111PR 03 2015 BU ILD,rIG DLi'AIk I LSI N I Uy' Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143, Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of this writer and include a reference to the captioned insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by First Class Mail. S. BLANEY Adjuster 3/31/2015 TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, AIA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 Permit Number — — 7 Date Issued Expiration Date $50.00 TRENCH PERMff Pursuant to G.L. c. 82A f and 520 CMR 7.00 et seq.(as amended) TIIIS P[R.Nrr MUST BE FULLY COMPEKTED PRIOR TO CONSIDERATION NaneafAppiiaatzyA Phoat CCU Street AddreaF'• 5,o'8-- 1 1 0 :� 6 Nave s( Excavator of different from applicant) Street Address Naos of ownerisl ut Preptrtr Pborr Strut Addrw �� _ -� 7 (— 7'7 `8� 33 _�� w 72'c --Q•, S. `C4<,,, I I nes c 6 usacrtptloa, location and purpose of pmpsosd lrt«lu Please describe the coact location at On propped traKh and its purpose I Inctuda a description of what In for Is lnkmkd) to bs hdd In proposed trench (ep plpedcabit Uaa ele_l pin= use raserss side uadd;tk al space Is needed. . �!--;, -1 Nj Zpi�,( iInsurrne Certilksto +: loPC) Q Y 8 6 3 0 i Rams one Contact larormatbn of Insurer: IMaar of Cnmptttnt Peron 1 as defined by SIA 011 7.[121: I of 2 a I E:oiratioo Late I�/�'./ 3 BY SIGNING THIS FORM. THE APPLICANT, OWNER. AND EXCAVATOR ALL ACKNOWLEDGE AND CERTIFY THAT I HEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED. INCIADING OSHA REGULATOOK% G.L. a 824. SA CMR 7.01 at wq, AND ANY APPIICABLIZ 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 SLIT 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 TIM PROPERTY TO MONITOR AND INSPECT THE WORK FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND REGULATIONS COVERING 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 PERMITAND THE WORK CONDUCTED THERSIMM INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIRZM EM of STATE LAW AND CONDITIONS OF THIS PERMIIT. 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 T7LEREWITH INCLUDING POT.ICK 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 ARL91 NG OUT or ANY INJURY, DRAM LASS, OR DAMAGE TO ANY PERSON OR PROPERTY DURING THR WORK CONDUCTED UNDER TIDS PERMIT. APPLICANT SIGNATURE DATE 146 h EXCAVATOR SIGNATURE ILF DIFFEREN-T) SA ",-e, DATE OWNER'S SIG�NATUREE (IF DIFFERENT) C/;��yra��--%--_ DATE: \4�tQ 2 of 2 Z1Lb�U1 Ib ty7 Building Owner's r iii IjES AT: Location QA (is 'b] 11Ch LN Name Type of Occupancy�ICrfTYF. New❑ Renovation ❑ Replacements Plans Submitted Yes ❑ No O (PRINTORTYPE) Check One: Installing Company Name ✓ torp• —T Address �11'rinClf C_��. ❑ Partnership S- ❑ Firm/Company Business Telephone C((�' 7� Name of Licensed Plumber' i(1C SQL? INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check on Owner ❑ Agen ❑ Signature or Owner or Owner's Agent 415 Vol 0 .0v 1 hereby certify that all of the details and Information 1 have submitted Signature of Licensed (or entered) in above application are true and accurate to the best of Plumber my knowledge and that all plumbing work and installations performed ('� under Permit Issued for this application will be In compliance with all —1q3 1 pertinent provisions of the Massachusetts State Plumbing Code and License Number Chapter 142 of the General Laws. Type: Master Journeyman ❑ Y Z �h y W Y y J N rn Q p U Q F> 7 N S. N Z N F W ¢ x !" Z _ O Z O Z N¢ Z WU cc O Q U Z¢ m¢ y Lu Q rn Z D Q Vl Z¢ a IL W x Q 3 0 z= Y p. Q Y W LL Y W Q t> Q S S2 Q. N O Q O Q O. O O .~ Q 3 x m rn o c g 3 x f- N LL Q¢¢¢ c0 S o Q 3¢ O Q m o SUB-BSMT. BASEMENT I 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINTORTYPE) Check One: Installing Company Name ✓ torp• —T Address �11'rinClf C_��. ❑ Partnership S- ❑ Firm/Company Business Telephone C((�' 7� Name of Licensed Plumber' i(1C SQL? INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check on Owner ❑ Agen ❑ Signature or Owner or Owner's Agent 415 Vol 0 .0v 1 hereby certify that all of the details and Information 1 have submitted Signature of Licensed (or entered) in above application are true and accurate to the best of Plumber my knowledge and that all plumbing work and installations performed ('� under Permit Issued for this application will be In compliance with all —1q3 1 pertinent provisions of the Massachusetts State Plumbing Code and License Number Chapter 142 of the General Laws. Type: Master Journeyman ❑ 6(1712015 SlipGen- Portal Home Town of Yarmouth ' Template [Building Dept] ffmm I In &AV Slipsheet Identifier [sg28080] Document Category Building Permits Map -Block Number 089.27 Street Number 0033 Street Name HATCH RD Department Building Parcel ID 12274 Backfile Batch Scan No Document? Additional Naming Info Index Operator Operator, Yarmscan Date - Time 2015-06-17 - 11:53 httpJnaser6che17/SllpGerV 1/1