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70 trench permit 2011 t • F M" -4'r14' -48 `b�,l ' Y 'i L .4 r f r3 t.A A- ' f y -i e a. ti"' 7 s•. SJ' .• rY h x j. t'1•.fit .. .,�"�tiP .etg " • , t L9dyy4 r..t '5.2 .. om l : �L, A 5 qJ .s : "' � Jw Y - ` ' v'x „ '''+ ' tt� " }1rg1 st F y ..4.4• om `f "i ?:_ . , 34 k er x' , a et s e..V 61 � b N ' w.s•x `e4 tN ;y:! "5. 5•_ V Fj' } .ritJ" •..4 t . , r Y ? - t rA ssy!!n YM C . +4 • .. .••f P ^ T 'k . .S rt JJltr �'C5 '$11 �' '' r . F xy ,p,ys, . y.�qF'w p.. 1f Ts t e•• 'i 'asyf66. cf ; r -Al' 4 .. �r` .. tr Y - it., ••F:� d.K: : e k ? %J$ q5Y' � Fr B-' ,• .. p'' rd•},1'i J•• Wy • .` r •I. OF NORTHAMPTON : APARTMENT OF PUBLIC WORKS 123 Locust Street Northampton,MA 01060 Phone 413-581-1570 PAX 413-587-1576 Penpit No. ASAP 70 COUNTRY WAY, FLORENCE 6253 DISAPPROVED Date IssueQ:-,_ .422/2011 By (Depv[ment of Public Works) Flo wmktC start until signed TRENCH PERMIT Pursuant to G L v 82A 5 I.and 520 CMR 7.00 et seq. (as amended) : THIS PERMIT MUST BE'FULLY COMPLETED.PRtORTO CONSIDERATION This permit(License for excavating on any public way and private properly)is issued under iht provisoasofM.G.L.c 82A S and 52Q CMR 1400 and Section 285-21ofthe Revised Ordinances of the City of Northampton subject to "Specifications for ofSUma CWd'ig ogdad adtpfd by the Dearbnem of Public Works on Seot ber21.1 991.The applicant heathy agrees to protect as curs with bmicadeb and lights eadto swethe City of Northampton hamdess from all claims for damages whatsoever azamg from the occupation of all propeties affected by tais permit,until such time as the work has been approved and by the Department ofPublic Works as Ixmided;forbelow,and in the case of private utility,to pay at charges for resurfacing. _ Fee:$250.00 Check 778 Valid for 3O days from date ofapproval.Expiration Date: 5 • Name of Applicant RICH ARDJAESCKE Street Address 774 BRIDGE ROAD City/Town STATE ZIP NORTHAMPTON MA : 01060 Phone Cell 535-0775 RICHARD Phone Cell Name of Excavator(if different from applcant) SAME Street Address City/Town STATE ZTP Name of Owner(s)of Property MITSCHICA&GABRIELLE HARTLEY Street Address 70 COUNTRY WAY City/Town STATE ZIP FLORENCE 91062 Phone -Cell Location of premised trench: 70(YICAYIXY pay, JWWiCE d Description-and purpose of proposed trench:please describe the exact lonatipu of the proposed trench sod tivwpose.fadlude a description of what is(Or is intended)to be laid in proposed trench(es pipestcte lines etc...) PERCTESTNEEDED ASAP Estimated dates of occupation of street. :ASAP Insurance Certificate#: - ON FILE Name and Contact Information of Insurer ON FILE Policy Expiration Date: '.ON FILE Dig Safe#:. ,2011-174768 ALL PERM SSISSUED PURSUANT TO 521 CMR 14.00 SHALL.BE POSTED IN PLAIN VIEW ON THE SITE OP THE TRENCH Note-Contractors will be charged for Inspections requested outside of regtdar working hours(7•0 a.m.-3:0Op4a,WEE) Contractor to notify DPW when job is in progress.: Engineers need ties to this service for our records. - INFRA-RED SHALL BE REQUIRED AFTER TRENCH CUT IS MADE.. 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'!• Y-Vii-t:-.."-• :. .4 .. 4,-.......„ • i,,,,:,...•4:. . .. q..-,, • !: .. .. . ..•..• • . -.. :b.,. •-..,.....• ....,,....:,,,.. ._ •,-.,- ,,..„...,•, ..•• . . ... ...,,,to..„.•• • ..,--,34,....., ,,. • :. ,,,,,: , -,... . . • . . . • _ • .....:. . . • _,,,„ott_L,, ‘...... -........ . • ,..„:„..: .. • . . • .• • •. • •• . .. .. .. . • • •• . • . ., .. . • -,- ..- . _ .. •.. . . • . . . • .. • • MAP 70 COUNI$YWAY, FLORENCE i BY SIGNING THIS FORM,THE APPLICANT,OWNER,AND EXCAVATOR ACKNOWLEDGE AND CERTIFY THAT THEY ARE EAMILJAR WITH OR,BEFORE COMMENCEMENT OF THE WORK,WILL BECOME FAMILIAR WITH ALL LAWS AND REGULATIONS APPLICABLE TO WORK PROPOSED,INCLUDING OSHA REGULATIONS,G L e 82A,520 CMR 7.00 et.Seq,AND ANYAPPLICABLE MUNICIPAL ORDINANCES,BY-LAWS AND K EGU AVOI4SAND THEYC(H'E&ANT AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WRI.COMPLY MELEWITE IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW. THEONDERSIGNED OWNER AUTHORIZES Ih APPLICANT TO APPLY FOR THE PERMIT AND THE EXCAVATOR TO UNDERTAKE SUCH WORK ONTHE PROPERTY OF THE OWNER,AND ALSO,FOWTTIE DURATION OF CONSTRUCTION, AUTHORIZES PERSONS DULY APPOINTED BY THE MUNICIPAUTTTO ENTER UPON THE PROPERTY TO MONI OR AND INSPECT THE WORK FOR CONFORMITY WITH ITIECONDITIONS ATTACHED HERETO AND THE%AS AND REGULATIONS GOVERNING SUCH WORK. THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSBSINCIURRED BY THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED THEREUNDER,INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OFSTAIE LAW ANDCONDITIONS OF THISPERMIT,INSPECHONSMADETO ASSURE COMPLIANCE 7'IIEREWITH,ANDMEASURES TAKEN RYIHEMUNICIPALITY TO PROTECT-DIE PUBLIC MIME THE APPLICANT' OWNER OR EXCAVATOR HAS FAR PD TO COMPLY nIEREWTIH INCLUDINGPOLICE DETAI,SAND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY TTIE MUNICIPALITY. 'THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY ANDSE BAILY TO DEFEND, INDEMNIFY,ANDHOLIIHARMLESS THE MUNICIPALITY AM)ALL OF ITS AGENTS AND EMPLOYEES FROM ANY AND AL#,LIABII,I'I'Y,GAUbIPffi`,ONACTIRFcQ$fl ANDS PENSES RESULTINGIRIOMOR MUSING.our OF ANY INJURY, EATH;LOSS,OR DAMAGE TO ANY PERSON ORPROPERTY DURING THE WORK CONDUCTED UNDER THISPERMCT. APPLICANT SIGNATURE EXCAVATOR SIGNATURE{IN.DIFPtR OWNER'S SIGNATURE(R+DWEE