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HomeMy WebLinkAboutDrain Layers Permit 8 Nutmeg Road (8) 800032 TOWN OF SOUTH W I N PERMIT NUMBER D S O R, C T DRAIN LAYER PERMIT DATE: 07/02/08 +�. GIS ID: 65100008 MUNIS APPLICATION# 200801 "F 006 FEE: 60.00 olV EXPIR ATION I O N DA TE:T E: 08/01/08 APPLI CANT. NAME: 6f^} f'a LEVAcx co. +....+ --:-LOCATIONADDRESS: 4 '` ' 7jSSr.:. :: '<:. 52 MAIN STREET }` Ll 1VIE ROAD SOUTH W �:+ ELTY T 1NDS0 C RANSFER LLC 4: : r`.y. ::: a. � s s R� DR IVE PH ONE O NE H �. E � � E CT 06 040 04 0 WO RK RK DESC RIPTION: RI P T I O N• RE L O C AT� S �>� .. i✓ �'! �i. ` THEDR IN LA YER E R AS SIGNED I GNE D T O TH I S F RMI .... ::. >THE TERMS AND CONDITIONSIN?' ; SET FORTII .Lr " � 11E STAB TE AND HEREBY AGREES TO ALL THE TOWN OF SOUTH WINDSOR STAND �_ TAC .f }IS La. "SHALL BE ARCS>"Ali ( " IN ACCORDANCE WITH THIS`-ITTACHED CONDITIONS. c ISSUE .... �w DATE 1NS ECTED �i2iaoos 4:is PM INSPECTED BY APPLICATION FOR DRAIN LAYER PERMIT TOWN OF SOUTH WINDSOR 4 PPl--# c2 a4 d O/OO-6 PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $60.00 Location of proposed work:_ v�`�� -!Zr . Lot # Street No. Street Name Premises ownedZan Name of Firm: _ /Y e e / i L2- Phone: Address of Firm: 1?ilJ��'�d Y TYPE OF WORK: Lay House Drain_ ; Repair House Drain Lay Main ; Lay Lateral for Commercial/Industrial Building of acres Connection will be made with Existing Water Supply: Public Water Well Proposed Start Date - 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 _ � � y� the holder of Drain Layer's License No. Only holders of P-1, P-7 or W-9 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. CBYD No. 9 Print Name: Licensed Drain Layer Date: : Standard:Form\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc TOWN OF SOUTH WINDS OR INSPECTION REPORT PERMS NO•: S>®o® S -�>, LOCATION: CONTRACTOR: TYPE OF WORK; DATE INSP NEEDED: _.- . INSPECTED B1': gt DATE INSP: WORK IN PROGRESS; Pve E ` S�� • rr 6 �. �cV� AS-BUILT: INPCJT-; DATE: - I -n t� W/2007 Town of SOUM Windsor INPSEMON REPORT 07 TOWN OF SOUTWI I N DSOR DEPARTMENT OF POLLUTION CONTROL r South Windsor, Connecticut DRAIN LAYER'S PERMIT 324 19 Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform the work indicated below ati �,—.a.�..mis �&Ivft�L�1 on the side at premises.owned by, {fp whose address is cOb.f p5' and to Lay House Drain, Repair House Drain, Lay Main, Other for - occupancy or use, with Family-Units, with - acres. Type of Sewage to be connected under this permit: SANITARY SEWAG4, INDUSTRIAL WASTES, OR Connection will.be made with Permit'to be issued to the holder of Dra!&Layer's License:No._ Permit will-expire on 19 The undersigned Drain Layer hereby agrees to'all the terms and conditions set forth on the per �nd tie reverse sid thereof. Applicant has,received Town Permit No. and/or C H D-Permit No. for street excavation,- SPECIAL, CONDITIONS. Ail Signed s ' Connection Charge Paid*-- Licensed Drain Layer (Sig) Issued by KA am t A Tax Collector Permit Fee: Paid t INSPECTION: INITIAL (Sig) FINAL (Sig) APPROVED *, a, ' € (Date) .A e (Sig) INSPECT f TRANSFER _ '` N�ERPRISE '-INC 1 t 1�40 PrS�gress Drxre80)533-333 Ma ot�esteY>CTP Fax ( �0) 33 33T 7ulai7 ie9490@aol.corn Strowroom;($60)645=9090 1 ` F/isit Our Website:snrww tede�k com i" James D.;Aldrich jaQaldcon.com Aldrich Construction Com any Inc. _ - P Y� .1395 T011dnd Turnpike v Manchester, CT 06042-1632 -(:860)647-7544 (860)645=0138 fax a P=�' ' TOWN - OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS STREET SUBDIVISION: NORTH ARROW Te 00, 1 i 1 + F ! _ 1 i ti 4-- I I A � f Z- c � CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT) STREET ADDRESS SIG T E 4f)Zo �TDATE TOWN STATE / ZIP INSPECTED BY TOWN —� -:� / DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER AGVRD L;tK I II-IUA I t Ur LIAbILI I Y INSURANGE CSR ME UAIC(MMIUU/TTTT) BARGE-2 05 30/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Evans, Pires & Leonard HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 121 Roberts Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fast Hartford CT 06108 Phone: 860-289-6816 Fax:860-291-8848 INSURERS AFFORDING COVERAGE NAIC# INSURED �Q INSURER A: Travelers INSURER B: Barber Utilities, LLC INSURERC: P.O. Box 331 35 Pinnacle Road INSURERD: Ellington CT 06029 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS — POLICY EFFECTIVE POLICY EXPIRATION LTRkNSRO TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A j X COMMERCIAL GENERAL LIABILITY 680-9559C622 06/01/08 06/01/09 PP'REMISES(Eaoccurenca) $ 300,000 CLAIMS MADE a OCCUR MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $ 1,000,000 _ GENERAL AGGREGATE s2,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 j POLICY PE LOC I AUTOMOBILE LIABILITY A ANY AUTO BA-9559C634 06/01/08 06/01/09 (EaCOMBINED SINGLE LIMIT $ 1 000 000 CO accident) r r ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIREDAUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ i PROPERTY DAMAGE $ (Per accident) I AGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE s2,000,000 A X OCCUR [::]CLAIMSMADE CUP 5847Y612 06/01/08 06/01/09 AGGREGATE $2,000,000 I $ DEDUCTIBLE $ X RETENTION $10,0 0 0 $ WORKERS COMPENSATION AND TWUbIA LIMITS ER A EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE UB-9559C646 06/01/08 06/01/09 E.L.EACH ACCIDENT $500r 000 OFFICERIMEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE s500,000 l yes,describe under --- SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,0 00 OTHER A Equipment Floater 680-9559C622 06/01/08 06/01/09 Equipment 452,014 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The Town of South Windsor is named as an additional insured with respect to General Liability. CERTIFICATE HOLDER CANCELLATION sowims SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town Ha Town of South Windsorll-Building Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 1540 Sullivan Avenue REPRESENTATIVES. South Windsor CT 06074 AUTHORIZED REPRESENTATIVE ITimothyJ Evans ACORD 25(2001/08) ©ACORD CORPORATION 1988