HomeMy WebLinkAboutDrain Layers Permit 12 Robins Wood TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7138 Contractor DEBRIKO/BRIAN KOCHER D/B/A
Location 12 ROBINS WOOD WAY Address 50 ELM STREET
Type Work NEW SAN LAT VERNON CT 06066
PhQie,,No. (860)870-9746
Date Insp Needed
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Per*mi t No. 7138 Town of South Windsor, CT
Permit Date 04/24/2000 Drain Layer Permit
E),piration Date 05/24/2000
Descrip:
Applicant Location
Name DEBRIKO/BRIAN KOCHER D/B/A Addr- 12 ROBINS WOOD WAY
Addr. 50 ELM STREET `0 r LUKASIK, JAN & ELIZABETH
VERNON CT `0S } 6
Phone No. (860)870-9746
The Drain Layer as,sl-g net r h,is permit has a vat i d license issued by the
state and hereby agrees t-o 11" the terms and conditions set forth in the
attached 'Conditions' A11 Works 11' , in accordance with Town of South
Windsor standards, all OSHA",,,,requtr' + an t an d , the attached conditions.
Issued By fez �-
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Date Inspected �' ,Inspected By' J QNA
Fi�A L i,Js�r+�
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: r Lot
Street No. Street Name
Premises owned by: 5
Name of F i m: ��T Phone:
Address of Firm: [
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection:will be made with Lt 0
Proposed Start Date Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
.ALL-OSHA,REQUIREMENTS`A-Nb--CONDITIiONS ATTACHED TO-THE-PE RMIT
Permit is to be issued to jgr the holder of Drain
Dyer's License No. 0 3 Only holders of P1, P7 & W9 licenses will
e issued a per„-it. Perrin will expire thin y (30) days crier date u issuance. i he
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:Z210 A-A A 9L ,� Print Name:
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc