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HomeMy WebLinkAboutdrain layer permit 845 Main Street 900055 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER DRAIN LAYER PERMIT DATE: 09/21/09 ': � GIS ID: 54900845 MUNIS APPLICATION# 200901131 "'r'�X`, �y,> ° , A FEE: 60.00 EXPIRATION DATE: 10/21/09 s� Y/ Sx APPLICANT k. 7 LOCATION NAME: J&H SLATER CON STREET ADDRESS: 75 COMMERCE W �Y :<..:' �. SOUTH WINDSORr 'z �° r SCOTT R&LISA F ,�67 ., # MA ST `Y X JT`WI$INDSOR,CT 06074 PHONE 860-521-525'2 K'> .. .3 g WORK DESCRIPTION: INSTAL �TI E I f f'_tTHE DRAIN LAYER ASSIGNED TO THIS, E I1` I A. ' IDSI 'D3lI .STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FOR`I? �t X . AC 1�T�5 �L ° ORK SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDAN t L I o> Ivdl'S �AS I�ATTACHED CONDITIONS. ISSUED BY,- , DATE INSPECTED INSPECTE BY 9/21/2009 10:33 AM TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: CONTRACTOR: LOCATION: TYPE OF WORK: DATE INSP NEEDED: DATE INSP: Iq d INSPECTED BY: WORK IN PROGRESS: S ` S/w C���' �, ��� � '' d9yc SD2 3� from 5+,tjl4 To y-e 11,o"a� A P A&th on 6cLv, jhChu.A. S�eeve a � `Too-�-.AA Clete► QK /0� o f 63 ecrcG AS-BUILT:_ [/ INPUT: L. J DATE: 1 31 , 01 W/2007 Town of South Windsor INPSECTION REPORT 07 r .. Awc:# 2oovoi!3 I APPLICATION FOR DRAIN LAYER PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, Cr FEE $60.00 Location of proposed work: Lot # Street No. Street Name Premises owned by: C0�, Name of Firm:_ 4't 7E12_ CAS i CsJ Phone: 5�8-�Z � Address of Firm: q5 ( M N �LEy�-_ TYPE OF WORK: Lay House Drain_ ; Repair House Drain ; Lay Main_ : Lay Lateral for Commercial/Industrial Building of acres Connection will be made with ��e-- Existing Water Supply: Public Water Well Proposed Start Date CS Estimated time for completion C � ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT Permit is to be issued to —CA ­5u- - the holder of Drain Layer's License No. _ 'Zo774 2 . Only holders of P-1.. P-7 or W-9 licenses will be Issued a permit. PERMIT WILL EXPIRE THIRTY(30) DAYS AFTER DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the terms and conditions set forth in the permit n attached thereto. Applicant has received Town Street Excavation Permit No. and/or ConnDOT Permit No. CBYD o. Sign Print Name: J4 Licensed Drain Layer Date: Standard FormsWermits\APPLICATION FOR DRAIN LAYERS PERMrr.doc 3 M H l N$ o i A f 4 + 9 6.8 s NIF RUSSELL TROTMAN CHESMR A ZANIEWSK/ ��i G �N 40 I PARKING an 42.5 Nr 1 �a�O ps 7.5 ol x 42.7 STA�f10E1 I x �2.7 5 I O x 43.0 wi, ear. � •o x Street Lhe 1 9• m m 200' 38.2 al% x ° eir. /130 3*.J v. SNEr SNL� j" S �.I CB _ / 40 +84 ASPHAL r — I 58(/2") tl /nv.3"3/3tm7 37.9ti. .3/P RC n'GRAVEI /nv 3S.26YI2 /nv357�R I 49•6 a/r. eir • 105'+ I x 37.9 6 �.-4O • 1, B52 3 ONAVA/F ANN C. NA U,GHH D=ems I I SNEr/533 IF FENTON 8 MARY FUT ER ---- A/N fists- STEELT.S : �- % WEL 3s.s 40 TOWN SOUTH W11036 R N/F Tf : 'h� �l ��' \N- 40 s '5093 870 I173,449. 57 863d 183,603.23 _.Cor4 Rao x 42.7 / N/F RUSSELL x 92. 7 TROTMANx 43 x 42.1 x 42.5 Q:a 44 �i 215�-t- lid x43.5 L x SN£r 6cs T SN£ 2 40---�- a3 4ao - t92 ASPHALT �- 40 — n GRAVEL I I RUS ED x,,40.1 I I x 37.8 65` � 9et Line 168'*_ 1 63�5`� 880 4/.2x 870 0o Q x40.4 �g3 6 36.5 x 1 � � 852 • s i � !' '!out, ■ I i � ■ ■ ■ ,' ■ ■ ■ ■ ■ ■■OWN AR WIMP Val i ! �. ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID EF I DATE(MM/DD/YYYY) HINCK-1 1 09 21 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE A Sterling Insurance Agency 0? HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 293 N. Maple St. , PO Box 727 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Enfield CT 06083-0727 Phone: 860-749-4782 Fax:860-763-1018 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Property Casualty - 19038 INSURER B: Hinckley Construction, Inc. INSURERC: 178 Highland View Drive INSURERD: Somers CT 06071 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. POLICY EFFECTIVE POLICY EXPIRATION LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 Ely A X COMMERCIAL GENERAL LIABILITY I660301R951ATIL09 09/25/09 09/25/10 PREMISES(Ea000urence) $ 100000 CLAIMS MADEFil OCCUR MED EXP(Any one person) $ 5000 PERSONAL&ADV INJURY $ 3.000000 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2000000 POLICY M PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 A ANY AUTO BA30IR951A 09/25/09 09/25/10 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIREDAUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1000000 A X OCCUR F—ICLAIMSMADE CUP301R951A 09/25/09 09/25/10 AGGREGATE $ 1000000 ADEDUCTIBLE $ X RETENTION $10000 $ WORKERS COMPENSATION AND X TORY LIMITS ER A EMPLOYERS'LIABILITY UB301R951A 09/25/09 ANY PROPRIETOR/PARTNER/EXECUTIVE _ / /09 09/25/10 E.L.E.L.EACHACCIDENT $500000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS all operations CERTIFICATE HOLDER CANCELLATION TOWNSOU 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 of South Windsor Public Works Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Sullivan Avenue REPRESENTATIVES. South Windsor CT 06074 AUTHORIZED REPRESENTATIVE iSterlingW. Putzel ACORD 25(2001/08) ©AC ORPORATION 1988