HomeMy WebLinkAboutDrain Layers Permits 144 Hayes Road 1700039 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 08/14/2017
GIS ID:40200144 FEE: 60.00
MUNIS APPLICATION# 201701068 EXPIRATION DATE: 09/13/2017
APPLICANT LOCATION
NAME: COLONY PLUMBING ADDRESS: 144`HAYES ROAD
ADDRESS: 216 SMITH STREET OWNER: HICKEY MAUREEN C&KARA KIRK
SOUTH WINDSOR,-CT 06074 144 HAYES ROAD
SOUTH WINDSOR,CT 06074
PHONE 860-214-1032
WORK DESCRIPTION: REPAIR HOUSE DRAIN
THE DRAIN LAYER ASSIGNED TO THIS--PE IT 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.
ISSILTED f3Y DATE INSPECTED INSPECTED BY
8/14/2017 8:55 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: / TO Qa 3 CONTRACTOR:
LOCATION: i q V ve d
TYPE OF WORK: �_P,0a i(
DATE INSP NEEDED: DATE INSP: 9-14--il
INSPECTED BY: J
WORK IN
PROGRESS: ,1, op." CSC v✓17%
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SEPTIC TANK PUMP , SMASHED, FILLED l WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: f �'v� DATE:�r ��
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 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: ! `1 b�"C� kOJ Lot #
Street No. Str et Name
Premises owned by:
Name of Firm: Co 6 P/Owlt ►v Phone:
Address of Firm: 2-/ 6 W, V"(
-TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with -Lz� r,�
Existing Water Supply: Public Water_ Well
Proposed Start Date lrlledl 7 Estimated time for completion z 3 I
ALL WORK TO BE IN A�ORDAigNCCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issu d to ® S ) the holder of Drain
Layer's License No. o . 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. �` PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 7S FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name: A
Lice n ed Drain Layer
Date:
Standard Form Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: AUG usi Zi"l
BUILDING ADDRESS ,14-4 I1AI,rS (
STREET
-I- SUBDIVISION:
NORTH ARROW
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CONTRACTOR ( INT) NAM OF C S U RVISOR (PRINT)
Z,16 Jry rok �
STREET ADDRESS SIG TURE
�-/►tip,-112- C-T DATE
TOWN STATE ZIP INSP BY TOWN
obi �i�}--i o 3Z. DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER