HomeMy WebLinkAboutDrain Layers Permit 44 Bailey Circle i
TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 7829 Con�X- 'ctor DOUBLE "'GC?�NSTRUCTI,ON LLC
Location 0044 4,AITAhY CT,C E;Acld �y P 0 mX T85 4'5. EVANS RD
Type WOSdk NEW SAN LAY � �.:,.$ 0�O,b7
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Permit No. 7829 Town of South Windsor, CT I
Permit Date 09/28/2004 wK•:,; Drain Layer Permit 1
Expiration Date 10/28/2004 mow'
Descrip: LAY HOUSE DRAIN
Applicant
Name DOUBLE C CONSTRU(AI.bN L2, c;g� Sd �QS$ATli$3( IgCL
Addr. P O BOX 785 45 EVANS F Y7 s SHADY gIIQK A�`SOCI'-`TES LLC
ROCKY HILL C3EI' ,06667
Phone No.
The Drain Layer Asa%gn el t s s 1 1 3tMae , sh ed by the
state and hereby agre."6;"to;'. he terms and Conti mn,�: �;�t:iaf�orth in the
attached 'Conditions `'All - ... .3 �;
��d c ar4oe WAth ToWn of South
Windsor standards, all, OSHA �c�uir�{n , aj
m k �, al�e at� y�3iec��Qo�sclitions.
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Issued Byf�'�h/
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Date Inspected " ::
p --------------------- Insp�"d`L`'ed'k,BY
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work:
Lot
Street No.
Street Name
Premises owned by:_ `hail y C�t� Caces
Name of Firm: Phone:
. 3
Address:of Firm: �I
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main Lay Lateraf for Commercial/Industrial
Building_____, of acres .
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date Estimated time for Completion ) ,do v
All WORK-TO BE IN ACCORDANCE WITH•TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUrREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit-is to be Issued.to the holder of Drain
Layer's License No. Only holders of P-1, P-7 or W-9 licenses
Will be issued a permit. PERMIT WILL EXPIRE THIRTY(30)`DAYS AFTER
DATE OF ISSUANCE. The undersigned Drain Layer hereby.agrees to all the terms
and conditions set forth in the permit and attached thereto.' Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
.CBYD No.
Signed: Print Name- ris , J
�h
Licensed Drain Layer
Date: IL
Standard Forms\Permit5\APPLICAIION FDR DRAIN LAYERS PERMIT.doe
TOWN OF SOUTH WINDSOR
SANITARY : SEWER LATERAL FlE: LD LOCATION
DATE OF :.CONSTRUCTION:.: 2 7 -
BUILDING ADDRESS yLl Ae_34 Lo4 is
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STREET
SUBDIVISION.:
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIG TURE -
DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER