HomeMy WebLinkAboutDrain Layers Permit 0559 Avery Street (2) 1500091 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
DRAIN LAYER PERMIT
DATE: 1 I/19/2015gO
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GIS ID:06300559 FEE: 0.00
MUNIS APPLICATION# 201501720 EXPIRATION DATE: I2/19/2015
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APPLICANT LOCATION
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NAME: MORAIS CONCRET S$RV. C ITC ADDRESS S59'A ERY STREET
ADDRESS: 108 ROCUS STREET .F= OWNER SOUTHWINDSOR TOWN OF
SPRINGFIELD,MA401)<�4 154}SU L IVAN AVE
4 s r sOIx WINDSOR,CT 06074
PHONE 413-20 j 217�r14
WORK DESCRIPTION: ItELOCT$ .AiL AS PART OF ROAD IEOQN> TI7G I ION PROJECT
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THE DRAIN LAYER ASSIGNED TO THISPE�IR HAS A ; LIGICIS1;ISSUED BuTHTr STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTS IN THL.,A!TTACI3ED`CQ ITI..:O7<I ' "ALL CORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,A A. OSHA TZEC�1 TIREMENT'S,AI D TEE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED tl/p 'SPECTED BY
11/19/2015 3:57 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: I CONTRACTOR: Il ��1/
LOCATION: �5 5 4 -e
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'TYPE OF WORK: Ado NS-j-ry c-�H.o
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DATE INSP NEEDED: iG . DATE INSP:_ _ f-z6 i
INSPECTED BY: �3
WORK IN
PROGRESS:
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SEPTIC TANK PUMPED,SMASHED, FILLED 12/A WITNESSED []YES ❑ NO
AS-BUILT-,--
INPUT:
S/molloy/fbrm 2014 Town of Sauth Windsor INPSECMN 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 proposes! work;_ 555) vt-(ZY Lot #
Street No. Street Name
Premises owned by: iCW,3 cf! T4 LAJI6ps,
Name of Firm: Ako4'ts, lkkr Phone: 44;
Address of Firm: la(5 �ncu_s S i�-rk7-t -Sern�v(gr;� MA c�ito4a
TYPE OF WORK: r LA-IsCeAL A' 90-: cf- ('ors 4Zr-CcraS; trTI" P(���C','
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with � � -- PUc, _g _
Existing Water Supply: Public Waterer Well
Proposed Start Date I1-11?5 -Z5' 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
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Permit is to be issued to ti) the holder of Drain
Layer's License No. J?x m U x o s 5 g 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. 152O"4 I and/or ConnDOT Permit No.
CBYD No. `Zo1!-4�v T 2. 5.3
Signed: ' Print Name:
Licensed Drain Layer
Date;
Standard Forms`Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 14pri' l ZCo Z�
BUILDING ADDRESS ��
STREET .5
SUBDIVISION:
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NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRAC OR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNAT6RE
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DATE
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T04N STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -- CONSULTING ENGINEER / DEVELOPER