HomeMy WebLinkAboutDrain Layers Permits 192 Pepin Place (2) 1600077 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/17/2016
GIS ID: 70700192
MUNIS APPLICATION# 201601716 FEE: 0.00
EXPIRATION DATE: 12/17/2016
APPLICANT LOCATION
NAME: T&M BUILDING CO,INC. ADDRESS; 192 PEPIN PLACE
ADDRESS: 110 BROOK STREET- OWNER: T&M BUILDING CO INC
TORRINGTON,CT 0679D 110 BIZbOK STREET
TOIW*TON, CT 06790
PHONE 860-883 5910.- -
WORK DESCRIPTION: NEW SEWER CONNECTION BUILDING 4 PERMIT FEE CE)LLECTED ON
APPLICATION 201601711 SO WINDSOR WOODS
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUED`BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH IN THE ATTACHED`CONDITIONS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED SPECTED BY
11/17/2016 10:41 AM �l 4
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: /6 00, -7 7 CONTRACTOR:
LOCATION:ja
TYPE OF WORK: J &0 �� ,� rfi o nprArj p," Mrja
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: -Ft411 �n�.s .4 �,/j .S i��/�r /U4 i(,✓f 6 1j,
r
SEPTIC TANK PUMP ,SMASHED, FILLED ti/3 WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: _Y � DATE: I `
S/molloy/forms 2014 Town of South Wlnc[mr MPSEMOWWORT 14
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: / I eV 156
Street No. Street Name �?�:► P��c,
Premises owned by: t�� e
Name of Firm: Phone:
Address of Firm: J�C3 z&2 C/ %lS
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 r �' Estimated time for completion -I a3 is
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 , ���'7�.cca.X. 725an T. 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. � 201CX5-0/F,.T S- PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 7S FEET OF A WELL
IT MUST BE AIR TESTED
Signe : V Print Name: C.i%,/ems ,G/oocy
Licensed Drain LayRK
Date: 141,11
—
Standard Forms\PermitMAPPLICATION FOR DRAIN LAYERS PERMrr.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: L� ; 6
BUILDING ADDRESS Z 1 :, 1%0 . 1'
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAM F C TRACTOR'S SUPERVI INT)
STREET ADDRESS
f+7 ,l✓ ? r - , DATE
TOWN ( STATE ZIP INSPECTED 60Y TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER