HomeMy WebLinkAboutDrain Layers Permit 0648 Avery Street (3) 1600086 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 12/06/2016
GIS ID:06300648 FEE: 0.00
MUNIS APPLICATION# 201601782 EXPIRATION DATE: 01/05/2017
APPLICANT LOCATION
NAME: RH WHITE ADDRESS: 648 AVERY STREET
ADDRESS: 41 CENTRAL STREET OWNER: PELATI:THOMAS S&NANCI M
P O BOX 257 648 AV`ERY STREET
AUBURN,MA 01504 ; - SOUTH WINDSOR, CT 06074
PHONE 508-832-3295
WORK DESCRIPTION: REPAIR SEWERLATERAL TOWN PROJECT NOFEE_HITDURING
INSTALLATION OF WATER MAIN
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.
ISSUED BY DATE INSPECTED i SPECTED BY
12/6/2016 2:54 PM
- - _ -
TOWN OF SOUTH WINDSOR INSPEMON REPORT
PERMrf NO:: p - CONTRACTOR: /_J
LOCATION: (v `l e &\%ff�4
TYPE OF WORK: '�ir
DATE INSP NEEDED.-- -2- '��5� DATE INSP: ' -2 -►y
INSPECTED BY,-,-
WORK IN
PROGRESS;
SEPTIC TANK.PUMP ;SMA iiED, FILLED V/A WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: Lam`` DATE:
9/mollay/forms 2014 Town of Sao Windsor MPSE(.TiON"REPOU 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT
FEE $50.00
Location of proposed work: (10yg Alevv
�ZS 2
Street No. Street Karne
Premises owned by: —Thnt'as 115
Name of Firm: Phone: OR 8323295
Address of Firm:
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with - Yl/C -
Existing Water Supply: Public Water k_ Well
Proposed Start Date Estimated time for completion _5 ���
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 ht" the holdei of Drain
- r- ces -No. / z szy1P7-O- I- oites off: —=7—or- 9ice es
will be issued a permit PEP34IT WI L EXPIRE T+llM_---30j-DAYS AFTER -
-- - ----
DAT-E t1F ISSUANCE. The undersigned Drain Layer iaere agrees to--all��eterms
1. cn fnrl-h the rya rnft&-A -14--kedI-V Fheraly� HlCan _ray e1Wed ------—
Town Street Excavation Permit No. /S=/o r2 and/or ConnDOT Permit No.
CBYD No. 2015-2 3o099 Y
Signed: A&4LA5E�!>—Prj1nt Nmrne:
Licensed Drain Layer
gate:
Ste, rd FormsWermb\APPLICATION FOP DRAIN LAY',-
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: q- �^
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
14
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
Au,6w v,- AA- DATE
TOWN �`- STATE ZIP INSPECTED BY TOWN
SCE C�, 7 J'� �o�`�S DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 7/19115
BUILDING ADDRESS yf A v e- � S
STREET
SUBDIVISION:
NORTH ARROW
-7-7-44
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
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TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER f
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER