Seq.(as amended) THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name of Applicant Phone Cen Phone Cen Phone Cen Street Address CitylTown MA ZIP Name of Excavator (if different from applicant) Street Address CitylTown MA ZIP Name ofOwner(s) of Property Street Address CitylTown MA ZIP Other Contact Permit Fee Received No( ) Yes ( ) Description, location and purpose of proposed trench: Please describe the exact location of the proposed trench and its purpose (include a d.
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How to fill out the Jackies Law online
Filling out the Jackies Law permit application is an essential step for those planning excavation projects. This guide provides clear and comprehensive instructions to help users complete the form correctly and efficiently.
Follow the steps to successfully complete the Jackies Law permit application.
- Use the ‘Get Form’ button to retrieve the Jackies Law permit application and access it in your editing tool.
- Fill in the date issued and expiration date at the top of the form, ensuring accuracy for your permit timeline.
- Insert the name of the applicant in the designated field, followed by their contact phone number. This identifies the primary contact for the project.
- Provide the street address, city or town, state, and zip code of the applicant. This ensures that the application can be properly processed and directed.
- If the excavator is different from the applicant, input their name and contact details in the respective fields.
- Record the name and address of the property owner in the allotted sections to verify ownership of the excavation site.
- Describe the location and purpose of the proposed trench. Be specific about what will be installed (e.g., pipes, cables) and if more space is needed, use the reverse side.
- Enter the insurance certificate number and provide the insurance provider's name and contact information. Ensure that the policy expiration date is also included.
- Insert the Dig Safe number and the name of the competent person responsible for the excavation as defined by the regulations.
- If applicable, include the Massachusetts hoisting license number, license grade, and expiration date for any individuals operating equipment.
- All involved parties (applicant, excavator, and owner) must sign and date the application to certify their agreement and understanding of the permit conditions.
- Review all entries for accuracy, save your changes, and proceed to print or download the completed form for submission.
Complete your Jackies Law permit application online today to ensure your excavation project complies with all local regulations.
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