HomeMy WebLinkAboutDrain Layers Permit 9999 Avery Street (3) 1500089 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/19/2015
GIS ID: 99990630 FEE: 0.00
MUNIS APPLICATION# 201501718 EXPIRATION DATE: 12/19/2015
APPLICANT LOCATION
NAME: MORAIS CONCRETE SERVICE,INC. ADDRESS: 9999 AVERY STREET
ADDRESS: 108 ROCUS STREET OWNER: TOWN OF SOUTH WINDSOR
SPRINGFIELD,MA01104 1540'SULLIVAN AVE
S WINDSOR,CT 060742734
PHONE 413-205-2172
WORK DESCRIPTION: RELOCATE MAIN AS PART OF ROAD RECONSTRUCTION PROJECT
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 SPECTED BY
11/19/2015 3:51 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: 1,5 000 CONTRACTOR: (hof A ►.S-
LOCATION: �° L� .4 �4
TYPE OF WORK:_ ���.a� -�
DATE INSP NEEDED: DATE INSP: 'J
INSPECTED BY: �
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED 0 YES ❑ NO
INPUT: DATE:I.),"\VUv
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S/mofty/forms tom Town of South Windsor IIVPSEGTm REPORT m
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: AyerzY- 5 r— A�t A "F �' of #
Street No. Street Name
Premises owned by: ic�L^°A) C'F wl"DScar—
Name of Firm: /IAoao 6:: xmTrz- fr�C�� Phone: �j3-Zx>-S-Z4-7Z
Address of Firm: 106 co �SrMVvi AAA 0 1049
TYPE OF WORK: nmu� k'S ?AXV of gvAr>
Lay Ho L se Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 1c>"frAz-?!3 QVG (2t.
Existing Water Supply: Public Water. Well
Proposed Start Date Estimated time for completion 12--lS-15
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 To S t D. A'G I?i?,= 1t2 the holder of Drain
Layer's License No. F k m it � v sg s Ck r . 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. t "- 1 and/or ConnDOT Permit No.
CBYD No, -Zoit- 464 f-?66
Signed: Print Name:-t) S � � , d �R rim
Licensed Drain Layer
Date: 114 / I z5
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc