HomeMy WebLinkAboutDrain Layers Permit 0571 Avery Street (2) 1500090 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 11/19/2015
GIS ID: 06300571
MUNIS APPLICATION# 201501719 FEE: 0.00
EXPIRATION DATE: 12/19/2015
APPLICANT LOCATION
NAME: MORAIS CONCRETE SERVICE, INC. ADDRESS: 571 AVERY STREET
ADDRESS: 108 ROCUS STREET OWNER: JONES ALEXANDER F JR&LYNN A
SPRINGFIELD,MA 011.04 57I AVERY STREET
SOUTH WINDSOR, CT 06074
PHONE 413-205-2172
WORK DESCRIPTION: RELOCATE LATERAL 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 ECTED BY
11/19/2015 3:35 PM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: LO . CONTRACTOR: P)O r(70 rr�'I�l�t
LOCATION:
TYPE OF WORK: r 1040 4'e— et4ela--e feqe-,r-�O-s
DATE INSP NEEDED: - DATE INSP: -9 -Z-6
INSPECTED BY: �S F
WORK IN
PROGRESS: (SAvon k
(04fe ir*1 . { wi&3 5AA�
SEPTIC TANK PUMPED, SMASHED, FULED N i WITNESSED EI YES ❑ NO
AS-BUILT:
INPUT:_ L DATE:
S/moHoy/forms 2014 Tom of South Winder IN swrim 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: I /�yE2Y' S-rr�r i Lot #
Street No. Street Name
Premises owned by: V LYNN Sew'or-5.
Name of Firm: 1.5 C-NJCMXIC I Qc- Phone: 4-C,-700 - -1-7 -
Address of Firm: TJP(,6AX-?H /VGA n+ioa-
TYPE OF WORK: t,�r n i LA;"i_ as eF (Zvr..r> rCrc�,��; -r► �
Lay House Drain ; Repair House Drain ->e ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with � :�>M-1S pvc- '-'inr,
Existing Water Supply: Public Water Well
Proposed Start Date i.i-t6-i5 Estimated time for completion
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 ��' 0 S y b , Co 'q z /'� the holder of Drain
Layer's License No. ),Mid Q S gb-Fg 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. 150026 { and/or ConnDOT Permit No.
CBYD No. '► - � �
Signed: " ate. - '
Print Name:
Licensed Drain Layer
Date: / r��
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: A Pr2. IL-- ,�I,, Z0 t co
BUILDING ADDRESS 571 A yr—fz-Y �-�-
�! STREET : A irk x-�4 :5+
SUBDIVISION:
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STREET ADDRESS SIGNATURE
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TOWN >z�i��2 —,j�.�. f i�r STATE 5,�� 1ZI P,aj/0�r INSP Y foWN
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TELEPHONE NUMBER IZIIJ
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER