HomeMy WebLinkAboutDrain Layers Permit 103 Cliffwood Drive TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 6558 Contractor GERSER CONSTRUCTION CO
Location 0101 CLIFFWOOD DRIVE Address 616 DART HILL ROAD
Type Work NEW SAN LAT - VERNON CT 06066
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Permit No. 6558 Town of South Windsor , CT
Permit Date 01,/21 /1997 Drain Layer Permit
Expiration Cate 0 -1/20/ 1997
Descrip- CONNECTION FEE ALREADY PAID
L, � � Applicant Location
Name GERBER CONSTRUCTION GO' 9108 .CLTFI=WOOD DRIVE
Addr . 616 DART HILL ROACH C3vner U & R, CONSTRUCTION �OMI'ANY 1N(�
VERNON CT 06(l66 `
Phone No. (860 )875-6684
The Drain Layer ass t greet .thl s perms has a \tjal d i`i tense issued by the
state and hereby agrees t6l, ail the terars And c:6ndi`t ions set forth in the
attached ' Cond i t i ons' . A f,l �wt rk '6ha11, sae ,fil accordance with Town of Sou Lh
Windsor standards , all OSHA r uirements, and tie attached conditions .
Issued By -` -- - -- --
--- _--- -
Inspected
-- -Date Inspected --------1 -- -----=- 'By ----
APPLICATION FOR DRAIN LAYERS PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE$25.00
.,� X
- Location of proposed work: l - �� d � Lot # �f
Street No. Street Name
Premises owned by: Y 41,C-�41 0 - -
Name of Firm: Ph ne: lam
Address o Firm: 6 1 (l�
TYPE OF WORK:
Lay House Drain Repair House Drain ,
Lay Main ; Lay Lateral for CommerciaVIndustrial
Building of acres
Connection will be made with
Proposed Start Date A I 1 Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR
STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO
THE PERMIT
Permit is to be issued to the holder of Drain
layer's License No. Only holders of P1, P7 & W9 licenses will be
issued a permit. Permit will expire thirty (301 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.
4-
Signed: `-" Print Name
Licensed Drain Layer
Date: �� v/-
TOWN OF SOUTH WIN OR
sANrrARY SERER INSPECTION CHECKLIST
FUNCTION NO YES N/A DATE INSPECTED
1. Is Permit On Job Site /21�
2 . Police Notified _1
3 . Safety Items In Place
a. Shoring, Trench Box, Ladder
b. Hard Hats 9D _
c . Pumps , ' z
4 . Proper Material
a. Pipe ICD _
b. Pipe Bedding --L_ -ILL
C . Backfill IRP / 2
d. Warning Tape 1 2J
e. Pipe Cap or Plug _
f . Cleanouts R
g. Fittings is
h. Manhole 90
i. Cover & Frame _ �31
5 . Existing Lateral Cap Removed
in Presence of Inspector
6 . Lateral probed and found
to be clear }{
7 . Pavement Cut Properly
8 . Trench & Bedding OK
9 . Joints Properly Donee 1J�)
10 . Backfilling (12" Lifts) Rb 121
& Compaction
11 . Manhole Inverts Built
12. Subbase Material Placed
13 . Base Material Placed
14 . Blacktop (Temp) w/Proper
Grades & Slopes
15 . Pressure Test �I�I
16 . Mandrel Test it'2I
ON
17 . Installation agrees with plan
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18 . As-Built plans recorded 7-V ��� �