HomeMy WebLinkAboutDrain Layers Permit 2400 Tamarack Avenue (2) 750080 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 12/18/07 A=
GIS ID: 89302400 FEE: 60.00
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MUNIS APPLICATI ON# 200702037
EXPIRATION DATE: 01/17/08
APPLICANT
=:.LOCATION
NAME: SIMSCROFT ECHO FAW9%.. s ` Dfq ESS "r'24001 °ABACK AVE.
ADDRESS: P O BOX 581 .„ <.;<:'r `.: ':
f:. ER:; ';;':.J ;V%RGRE'.N MEDICAL ASSOCIATES LLC
SIMSBURY CT "" ' ""`06070>: :a:%<:
,.: � "zF7 lI§mi DRIVE
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PHONE 860-651
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CRIPTION:
ION: PRIVA TE'SE' E
1� i3V` :`� • :�,: � �I, � 'E�'> , I�'BUI�,L�ING
TO BE INS'Ts I L THE`A'PI<CSVED'T b-i
THE DRAIN LAYER ASSIG
NED TO THIS T?ERMITU#1�a�:�k•:�;FAI;I � `: F S�:UIr}�'`
I�'.�z ; ;� B.'ix.;1'I��STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTk IN,;'�'HiS'" TAf,:.,. NS'. AL1 ,*C SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDSAL QHA Ts,AND TH1;ATTACHED CONDITIONS.
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ISSUED BY DATCINSPE ED INSPECTED B
12/18/2007 9:22 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:_ZSGO9�/ CONTRACTOR:_ '--,—i 144 s Grzl�
LOCATION:_
TYPE OF WORK:-1, sJI -//
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: G6�lr
WORK IN
PROGRESS:
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AS-BUILT:
INPUT: C -1 DATE:
W/2007 Town of South Windsor INPSEMON REPORT 07
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:/r n f 0 CONTRACTOR:
LOCATION:_
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:_ /� / `��✓✓fir Grt-�I�^ �� P�� C �� ? -1
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AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 75"06 E6 CONTRACTOR: S 1 CSC
LOCATION: 9 g D O j&j2n
TYPE OF WORK: - wol 1v--
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 'alb
WORK IN
PROGRESS:
AS-BUILT: t/
INPUT: DATE:
W/2007 Town of South Windsor INPSEC RON REPORT 07
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
apPl ' aX7OaO37 PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work:
Street No. Lot #
Streetkm
Premises owned by:
Name of Firm: Q
Phone: d�Fa,
Address.of Firm:
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main X • Lay.Lateral for Commercial/IndustrialBuilding of acres .
Connection will be made with
Fcvl�cdt
Existing Water Supply: Public Water__ Wei h vh
Proposed Start Date ��
-��� Estimated time for completion2 .
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARD-
ALL OSHA R�UIREMENTS AND CONDITIONS ATTACHED
-o6'aFy TO THE PERMIT S,
Permit is to be issued to-
Layer's License No. p 7 the holder of Drain
will be issued.a - Only_holders of -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
and conditions set forth in the 9 all the terms
Town Street Excavation Permit No, it and attached thereto. Applicant has received
and/or ConnDOT Permit No.
CBYD No.
Signed: (ID,
y Print Name: t A o
Licensed Drain Layer e ` �'�•
Date: 2- _ o-�
Standard Forms\Permits\APPLICAIION FOR DRAIN LAYERS PERMIT.doC