HomeMy WebLinkAbout184 Pepin Place 1600075 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/17/2016
GIS ID: 70700184 FEE: 0.00
MUNIS APPLICATION# 201601714 EXPIRATION DATE: 12/17/2016
APPLICANT ; LOCATION
NAME: T&M BUILDING CO.,INC. ADDRESS:' 184`PEPIN PLACE
ADDRESS: 110 BROOK STREET OWNER: T&M$UILDING CO INC
TORRINGTON, CT96790 110=ER60K STREET
ORRINGTON,CT 06790
PHONE 860-883-5910
WORK DESCRIPTION: NEW SEWER CONNECTION BUILDING 4"PERMIT FEE C(3LLECTED ON
APPLICATION 2016UI711 SO WINDSOR WOODS
THE DRAIN LAYER ASSIGNED TO TH1S PERMIT HAS A VALID LICENSEISSUED_ -BY ISSUEDY THE STATE AND HEREBY AGREES TO ALL
RTTI<TN T
THE TERMS AND CONDITIONS SET FOHE ATTACHED`CONDITIONS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED SPECTED BY
11/17/2016 10:38 AM
- - ---------------- --- -- -- - .
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO*:: /6 C)00 CONTRACTOR:
LOCATION: 1 3 it fefi n P1 4��
TYPE OF WORK: M,0 _�e�r C�✓�n c.riCr1 a �tal3���I
DATE INSP NEEDED: 1- -I.A 6 DATE INSP: i 1-1-Z✓!
INSPECTED BY: L s C�
WORK IN
PROGRESS: (%r._ r -17 A lUn v✓/ _s Tzi ag A/n r(i./+f M11 f-%ct,,L
SEPTIC TANK PUMPED,SMASHED, FILLED �'-�� WITNESSED ❑YES ❑ NO
AS-BUILT: �
INPUT: DATE:
Wmolloygorms 2014 Town of SmAh VAndwr INPSEMOWWORT 14
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: / I76' i ss-�i9�Lot # �
Street No. treet Name
Premises owned by: 7/71
Name of Firm: Phone:
Address of Firm: !C3
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,
h ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to ,� / -/,.r- g 74/,vt T. the holder of Drain
Layer's License No. cx5k-->=r 77. 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. n7a��'��So/83S PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signe Print Name:
Licensed Drain La
Date: leolll
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: tZ- (6
BUILDING ADDRESS Z 116, 1% , IM. l h '; , `, E24,-
STREET : �,�►� �1���
SUBDIVISION: U�mv
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NORTH ARROW �f L. �I, tAGA
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CONTRACTOR/(PRINT) NAM F C TRACTOR'S SUPERVI INT)
STREET ADDRESSE _
DATE
TOWN STATE ZIP INSPEC QED Y TOWN
`� ` DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER