HomeMy WebLinkAboutdrain layer permit 455 Sullivan Avenue Permit No, 7695 Town of South Windsor, CT
Permit Date 11/21/2003
Drain Layer Permit
Expiration Date 12/21/2003
Descrip: CONNECTION FEE CK#1¢'4976=<`
Applicant I t..ion
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Name PELLETIER BUILDERS $VIIIVA E UE
Addr. 138 MAIN STREET C Y r PARKS ',P,3-:PL,.NkETV'�WEBSTER
' 5 7
COVENTRY CT 06238 '
Phone No. (860)742-5�17
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The Drain Layer 'assigned dais11 2ti} T klasF u11dyen0e �.ssued by the
state and hereby age .tb .: fl.;: heterms "and cori`diit �eC:::::;forth in the
attached Conditions- All w€ xlc: shad yCC�`rdane"' tth Ton of South
Windsor standards, a1-1 OSIA">reuruti .`F;;9, X ? I� aGa: he ,C4iditions.
Issued By
Date Ins "ected --------------------- eC ' d y --
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No 7695 Contrad PELLETTEpl. BUILDFRS
Location iT�11N7EmI�t �icldrex: 138:. MA .N STREET
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Type Work NEW SAN LATL.VDNTY: fi
Ahoy No 42
Date Insp Needed Date Irl. :p 3iA3'
-------------�
Time Insp Needed Tit In , l►1.
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Inspected By
Work in Progress /
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11/19/2003 WED 15:06 FAX 860 644 7280 South Windsor Town Hall IM003/003
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: U I wQA�enuf' Lot#
Street No. Street Name
Premises owned by:�(-yS iAeE P t u n Ke-Ji' \L� jj �
Name of Rrm:- _ Phone: q�9�9�� 'Fs58 3
Address.of Firm:1 Ki i �a��� � �, Su I fir ICE
car� ` NG a�511
TYPE OF WORK:
Lay House Drain Repair House Drain ;
Lay Main Lay Lateral-for Commercial/Industrial
Building of acres
Connection will be made with Sc edo(e -AO- PVC
Existing Water Supply: Public Water Well
Proposed Start Date ��Ovo Estimated time for completion J a I d3
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 toP&��P_1 IP�1'� U11c7YP'S /i�C the holder of Drain
Layer's License No. .a2 Qelg ? 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 ttached thereto. Applicant has received
Town Street Excavation Permit No. A and/or ConnDOT Permit No.
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CBYD No. Q 6 DI 115
Sig Print Name:klc iaruA
Licensed Drain Layer
- Date:-- AD
c\ m Standard.Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc .. .. . - .. _
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TOWN OF SOUTH WINDSOR SA N I TA RY SEWER LATERALTIELD
LOCATION
DATE OF CONSTRUCTION: V R 2( *4 27"M 28#0 [�03
BUILDING ;ADDRESS �455 �ARrCS,rf>�s..t,�ldF -�
STREET 4 5 .5�_L',Md lA#. ij&kzm :cr
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CONTRACTOR (PRINT) NAM NTRACTO RVISOR (PRINT)
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STREET ADDRESS TORE
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TOWN STATE
STATE ZIP INSPECTED BY TOWN DEC 0 2003
DATE
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TELEPHONE NUMBER SOUTH WINDSOR
ENGINEERING DEPT.
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER