HomeMy WebLinkAboutDrain Layers Permit 31 Rimfield Drive- - 'rya,[,.iafi" r, i^+ r"�Pi? 2,r'��'`y 'i�•"'�C".!it�!fSny "�"a�c.{'y�`�+"'�'" ;5. _... -.
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5689
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to performer work indica d below t ,
at premises owned by u d_ 4.16 /NhuQ , whose address is
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and to
Lay House I Drain, . Repair House Drain, Lay Main, Other ,
for d7 4 occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE , INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
I
Show sketch of proposed work or furnish two (2) copies of separate drawings.
G,5 per (�o Io:,J
SPECIAL CONDITIONS
- Desired Starting Date 1 Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. S 4, 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 the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
Licensed Drain Layer
The above named Drain Layer has a valid license issu d by the State of Connecticut and
has filed a satisfactory, bond and insurance policy in the� iame of t own of South Windsor:
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/v E ineeri partment Date
Connection Charge Paid epn ' Pe it Fee: Paid $ Z,4
Che�,k Nu ber 33
Issued by - Z .
Tax Office
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INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
NO. g
19
RECEIVED FROM
D O LLARS
v
Account Total $
Amount Paid $_ 2-
IV
Balance Due $ // J
"THE EFFICIENCYO LINE"AN AMPAD PRODUCT-23-121
I Describe fully nature of permit requested.
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ih own of Sou Windsor
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10'89 DENNISON NATIONAL COMPANY
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I agree to furnish to the Town of South Windsor the amount of bond or deposit required and to
reimburse the Town of South Windsor for any expenses incurred by the Town for maintenance or repair
work in connection with this permit and that I am familiar with and will abide by the rules and
regulations for permits as outlined in the Town of South Windsor's vement t Regulations.)
Signed �.
APPROVED: DATE APPROVED: "I:� DATE
Supt. of Highways F1.70 Town Engineer
FOR INSPECTOR: Date work started Date completed
Sufficient notification received: yes no Type of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
P
Signed
Inspector
NATIONWIDE
INSURANCE --
® Nationwide is on your side NATIONWIDE MUTUAL FIRE INSURANCE COMPANY DECLARATIONS
HOME OFFICE:ONE NATIONWIDE PLAZA•COLUMBUS,OHIO 43216 w
NON-ASSESSABLE POLICY PERIOD BEGINS 12:01 AM
GOLDEN BLANKET POLICY: 51H0065-369 TERM INCEPTION 11-18-91 STANDARD TIME AT THE
CONTINUOUS RENEWAL EXPIRATION 11-18-92 RESIDENCE PREMISES.
1ST MORTGAGEE AND ADDRESS NAMED INSURED AND ADDRESS LOCATION OF DESCRIBED PROPERTY ADDITIONAL INSURED
THE BANK OF SOUTH PAUL K AND/OR 31 RIMFIELD DRIVE
WINDSOR DONNA V SHAW SOUTH WINDSOR NOT APPLICABLE
1695 ELLINGTON ROAD 15 BAYBERRY DRIVE CT 06074-0000
SOUTH WINDSOR HOLYOKE
CT 06074-0000 MA 01040-0000
*****TO REPORT CLAIMS, CALL 1-800-421-3535
INFLATION PROTECTION COVERAGE IS APPLICABLE.
We will provide the insurance described in this policy in return for the premium and compliance with all applicable
policy provisions. See policy for details regarding the SPECIAL LIMITS OF LIABLILITY and ADDITIONAL COVERAGE OPTIONS.
SECTION I COVERAGES LIMIT SPECIAL LIMITS OF LIABILITY ADDITIONAL COVERAGE OPTIONS
A-DWELLING $115,000 CATEGORY LIMIT OPTION LIMIT
B-OTHER STRUCTURES $11,500 1-JEWELRY-FURS $1,000# D-SILVERWARE $2,500
' C-PERSONAL PROPERTY $86,250 2-CAMERAS $1,000# M-PERS. INJURY APPLIES
D-LOSS OF USE $115,000 3-GUNS $1,000# THEFT BUILD MAT APPLIES
4-TOOLS $1,000#
SECTION II COVERAGES 5-SILVERWARE SEE OPT-D
E-PERSONAL LIABILITY $300,000 6-MONEY $200
PD/BI-EA OCCURRENCE 7-SECURITIES $1,000
F-MEDICAL PAYMENTS $1,000 &WATERCRAFT $1,000
TO OTHERS-EA PERSON 9-TRAILERS $1,000
10-MANUSCRIPT $1,000
OTHER COVERAGES LIMIT 11-COMPUTERS $3,000
-FIRE DEPT. SERV. CHARGES $500 12-BUS. PROP. $500
-CREDIT CARD-FORGERY $1,000 # APPLIES TO THEFT ONLY
AND ELEC. FUNDS TRANS.
-ACCID. DEATH-EA ADULT $2,000
-ACCID. DEATH-EA CHILD $500 SECTION II EXCEPTIONS: The residence premises is the only premises
-REPLACE COST CONTENTS INCLUDED owned or held for rental by the named insured or spouse, other than
-BLDG R/COST GUARANTEE INCLUDED business property, and is used solely for private residential
purposes. Exceptions, if any:
DEDUCTIBLE-SECTION I (In case of a loss NONE
under Section I, we cover only that part
of the loss over the deductible stated). SPECIAL PROVISIONS (Applicable only if indicated):
ALL PERILS $ 250 NONE APPLICABLE
EARTHQUAKE DED-2%,$250 MINIMUM
FORMS AND ENDORSEMENTS MADE PART OF POLICY: CONSTRUCTION FRAME NO. OF FAMILIES 01
FIRE 2702 TYPE OF ROOF APPROVED TERRITORY 38 CONS. YEAR 1991
PROT. CLASS 4 NOT MORE THAN 1000 FEET FROM HYDRANT
FIRE DISTRICT: 4 RATE PC 4 NOT MORE THAN 5 MILES FROM FIRE DEPARTMENT
INSIDE SINGLE CLASS AREA
BASE POLICY EARTHQUAKE TOTAL PACKAGES
PREMIUM I I I PREMIUM I 1 PREMIUM
$327.00 $53.00 $380.00
FIRE 2506 COUNTERSIGNATURE DATE: 11-18-91 AGENT AND NO. Ronald P. Morin,CLU,ChFC _ CT - 10509,