HomeMy WebLinkAboutDrain Layers Permit 12 Ellsworth Circle TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 6603 ' Contractor, JMJ CONSTRUCTION CO.
Location 12 ELLSWORTH CIR Address 658 ELLINGTON ROAD f
Type Work NEW SAN LAT SOUTH WINDSOR CT 06074
f?horle No. (H60 }528-7889
Date Insp Needed Date Ins
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Time Insp Needed Tame r nsp
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Inspected By
Wort: .in Progress
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Permit tvo. 6603 Town of South Windsor, CT
Permit Date 04/30/ 1997 Drain Layer Permit
Expiration Date 05/ >0/ 1997
Descrip : CONN REG 473E
App I i cant Location
Name JMJ CCi :j fRU< T ION (,0. �?cicYr . t '' Ei 1..4WORTH CIR
Addr . 658 E:t._LINGION k(�AD Owner ':JM.t t�CNSI"Re.JC1"lON
SOUTH WINDSOR CT O607.4
Phone No. (860)528-7889
The Drain Layer assigned this permit has a "valid 1)cense issued by the
state and hereby agrees to 'al l the terms acid conch t1 bri8 set forth in the
attached ' Conditions ' . All wore,, shall be in ,accordance with Town of South
Windsor standards , all OSHA requ i rements, and .the Attached conditions .
Issued By _ k
Date Inspecte __._=.zL1-t-_r17___ . .._ _ Inspected By --- --
APPLICATION FOR DRAINLAYERS PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE$25.00
�G� a
Location of proposed work: % � l i 0/d �,�dGf� Lot #
Street No. Stre
et Name
Premises owned by: T of T- 6-012 S
Name of Firm:— Phone:
Address of Firm: t R
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with a
Proposed Start Date�(-130"Estimated time for completion D� k ,�
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 �' r
: /V)75 C ,�; the holder of Drain
layer's License No. Only ho ers 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: ,✓� t C-
Print Name �r,� ,1 � �'
tens Drain Layer
Date: 71 C
TORN OF SOUTH WnWSOR
SANITARY SERER INSPECTION CHECKLIST
FUNCTION
NO YES N/A DATE INSPECTED
1 . Is Permit On Job Site y3/
2 . Police Notified EL
3 . Safety Items In Place
a . Shoring, Trench Box, Ladder
b• Hard Hats
C. Pumps to
4 . Proper Material
a . Pipe
b. Pipe Bedding _��
c. Backfill Pp
d. Warning Tape
e. Pipe Cap or Plug i p
f . Cleanouts 0
g. Fittings -
h. Manhole 77—
i . Cover & Frame
5 . Existing Lateral Cap Removed RIJ
in Presence of Inspector
6 . Lateral probed and found
to be clear 99
7 . Pavement Cut Properly
8 . Trench & Bedding OR
9 . Joints Properly Done pi(�
10 . Backf filling (12" Lifts ) !�
& Compaction
11 . Manhole Inverts Built f�l�
12 . Subbase Material Placed R D
13 . Base Material Placed
14 . Blacktop (Temp) w/Proper /
Grades & Slopes /
15 . Pressure Test Ry
16 . Mandrel Test RO
17 . Installation agrees with plan Iql) _
18 . As-Built plans recorded ��