HomeMy WebLinkAboutDrain Layers Permit 1645 Ellington Road (2) . TOWN OF SOUTH WINDSOR INSPECTION REPORT {
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Permit No. 7022 Contractor GERBER CONSTRUCTION CO !
Location Address 616 DART HILL ROAD
Type Work SAN MAIN VERNON CT 06066
Phone No. (860)875-6684
Date Insp Needed e,7/99"^ _ Date Insp.
Time Insp Needed Temp;Inp` ray`?
Inspected By i
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Work in Progress �c/ST � ti!• ����
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Tnut Date
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Permit No. 7022 Town of South Windsor, CT
PernV 04te 0�/e3-/4 999 Drain Layer Permit
Expirion Date 08/22/1999
Descrip':. BANK OF ROCKVILEE EXTEND LATERAL INTO LOT
Applicant Location
Name GERBER CONSTRUCTION CO Addr. .
Addr. 616 DART HILL ROAD 0Wner
VERNON CT 0¢Q86
Phone No. (860)875-6684
The Drain Layer a sTigrle t !"h*a va l i d Ti cense issued try the
state and hereby agrees 1;0:" llthe"; rt�te "and";ctiitios set forth in the
attached 'Conditions';.` A 11 4ork 'shal'1, be;:"£i n accordance with Town of South
Windsor standards, aY1 . QSHA" rqu�rttetat =:and .the' attached conditions.
Issued By �--y--' T ti
finspecte
Date Inspected 7/ d 'By
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT-
FEE $25.00
Location of proposed work: �
� Lot #
Street No. Street Name
Premises owned by: A4rkae aC r,liz
Name of Firm: 6;v--c�7Z Phone:
Address of Firm: 6�61- jor�
TYPE OF WORK:
Lay House Drain ; Repair House Drain
La Main
La Lateral
l for Commercial/Industrial mercial/Industrial '
Building of acres
Connection will be made with
Proposed Start Date �'Z r�' 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 � xn Cis- the holder
o der of Drain
Layer's License No. 12-2 -JS��. Only holders of P1, P7 & W9 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.
Signed: 141;e 5,�
Print Name:
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMrr.doc
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CONTRACTOR (PRINT) NAME F ONTRA R' S PERVISOR (PRINT)
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TOWN - -- �----J ISTATE ZIP INSPECTED BY OWN
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TELEPHONE NUMBER ' :
WHITE TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER DEVELOPER