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HomeMy WebLinkAboutDrain Layers Permit 206 Buckland Road (2) 800003 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: h a GIS ID: 15300206 MUNIS APPLICATION# 200800062 r ° ::: <. "z" ``' FEE: 60.00 EXPIRATION DATE: 02/22/08 AP NT> PL C ,.A H iOCATION NAME: SIMSCROFT ECHO FA`: S S ADDRESS: �7< UCKI AND ROAD P O BOX 581 C `VILLE MARRION SIMSBURY C 1. &ROY TRUSTEES T { <f4 C; $iIG. =AND ROAD JTH"WIN PHONE r:.. ..>N.4 D SOR,CT 06074 860-651-f�23'T"`' s'f f'a W O RK DESCRIPTION: �`. r : LA Y 6 00 FBI' Itr THE DRAIN LAYER ASSIGNED TO THIS PY Rl H1 S`'VA £ ` aS JED t.. S. ATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORTH' V`ITF,A A Ek a itl ON&W..-Al �©1 SHALL BE 1N ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDARD'-.ALk SAA: ;UiIv `' ND E;: TTACHED CONDITIONS. SUED BY d 1/23/2008 11:53 AM DATE INSPECTED INSPECTED BY TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: 8 000 03 CONTRACTOR: S i vn5 C Y O IL LOCATION: ®(o Au,--L-(0 r" TYPE OF WORK: -Sewer_ DATE INSP NEEDED: DATE INSP: INSPECTED BY: WORK IN PROGRESS: I f2� Sal s� ►�,. -- �y��r�i zIFF f �� , 41 �� F,r.,sLc� ��f� L � 5;aw m I, w �a V AS-BUILT: INPUT: (J�°- — DATE: �-� a W/2007 Town of South Windsor INPSECTION REPORT 07 TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.:_eaGGU2 CONTRACTOR: LOCATION: c TYPE OF WORK: 5e wA- DATE INSP NEEDED: DATE INSP: INSPECTED_BY: WORK IN PROGRESS: Y 's,0 /VI/-/ #c 14 q l l o 1 o c; ra l ekok S m k Prof. Let..—c. _�lo r Z4"1 & fe i ZTo mSCP$ ''rt 5 Sn�i rs ;vx SMa 4 AS-BUILT: INPUT: DATE: W/2007 Town of South Windsor INPSECTION REPORT 07 APPLICATION FOR DRAIN LAYER PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, Cr FEE $60.00 Location of proposed work: 0 0 . Lot # Street No. Street Name Premises owned by: R "T'wu.s 4' Name of Firm: ` 1 a u�v^S Phone: Address.of Firm: O 6 TYPE OF WORK: Lay House Drain-___-----; Repair House Drain . Lay Main - oa Lay-Lateraf for Commerdal/Industrial Building of. acres Connection will be made with 4 Existing Water Supply: Public Water Y/ Well Proposed Start Date . -LA z— 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�Fyns c -r?- , l ,�s layer's License No.�,Cn? the holder of Drain will be issued a — � 6-P • Only holders of P-1, P-7 or W-9 licenses 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. Town Street Excavation Permit No. Applicant has received and/or ConnDOT Permit No. CBYD No. 0100 903cx�'q $6 Signed: Print Name: OUr\(� Licensed rain Layer Date:_ Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc THE JACK CONSTRUCTION MATERIALS PHONE 860-243-9714 97 OLD POQUONOCK ROAD 1-800-423-0112 FARRELLY • BLOOMFIELD,CONN.06002 FAX 860-286-0867 COMPANY 150 UNIVERSAL DRIVE(Rear) PHONE 203-777-5548 • NORTH HAVEN,CT 06473 FAX 203-777-3147 COLTON ROAD PHONE 860-739-5457 EAST LYME,CT 06333 FAX 860-739-8513 149 SOUTH WEST CUTOFF PHONE 508-752-PIPE WORCESTER,MA 01604 FAX 508-797-4455 176 CHASE RIVER ROAD PHONE 203-759-1135 WATERBURY,CT 06704 FAX 203-759-7522 WATER/SEWER TEST REPORT PROJECT/LOCATION: f�1 ac 1_ 1_{ c{ l; c�' �<>,1,4 C' Z u -,k 1 INSPECTOR: TESTED BY: W i 11 1 0'-� DATE OF TEST: S / I /ztz CONTRACTOR: HYDROSTATIC TEST WATER MAIN TEST❑ SEWER MAIN TEST M LENGTH OF TEST: STATIC PRESSURE: TEST PRESSURE: ALLOWABLE LEAKAGE: ACTUAL LEAKAGE: TEST RESULTS: PASSED ❑ FAILED ❑ REMARKS: AIR TEST !" MANHOLE TEST PRESSURE TEST RESULTS NUMBER IN P.S.I. TIME OF REMARKS OR STATION START STOP DROP IN MIN. TEST I certify that the above information is a true and accurate account of the tests performed at this location. SIGNED: see,'—.- J11 INSPECTOR TESTER irr � � � 1 ■ rr � � � � 1• •1 . ■■ ■ ■ ■■ ca I I ho'lil m I ■ ■■Evl ■ I AMON V fm I all willNOW D ZT5711• .11• 1, / 1 � 1 1- 1 1 1 /•