HomeMy WebLinkAboutDrain Layers Permits 50 Andrews Way (4) 1600034 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/23/2016
GIS ID:03200050
FEE: 60.00
MUNIS APPLICATION# 201600845 y sW EXPIRATION DATE: 07/23/2016
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APPLICANT Y w LOCATION
NAME: BUTLER COMPANY QDDRIrSS0 ANREWS WAY
ADDRESS: 848 MARSHALL PHLIys zOAD O�UNER SO�UTI WINDSOR DEVELOPERS LLC
WINDSOR,CT 0605 ` 2 14fAIT STREET SUITE 100A
$ 4
,. CH�THAM,NJ 07928
PHONE 860-68$ 8024 F
WORK DESCRIPTION: NEW SI�WER�ONI�TCTION COIVIMI;RJC�iL B�I�LDINCr#l5 UNITS 501 —504
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THE DRAIN LAYER ASSIGNED TO THIEIII H1S Ai�ALID T,ICEi+ISE ISSi)ED BYH STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR`Hl THQk.l FA8hE` z ONDITI.ONS I L V ORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STAND t RDS, I L OSHA REQUIREMENTS 1L`ID ZF E ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
6/23/2016 8:43 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: CONTRACTOR:_ Gtl��
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: r
INSPECTED BY: /3 p
WORK IN
PROGRESS: ,z -5 ,2 o
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: -- DATE:
S/molloy/forms 2D14 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
1540 SULLIVAN AVENUE
PUBLIC WORKS DEPARTMENT
TOWN HALL
SOUTH WINDSOR,CT
FEE$60.00
-Location of proposed work: � 0 , e cq O��e �,4_Lot#
Street No. Street Nam
Premises owned by: ----'1-x? 42,
Of
Name of Finn: ' :7- _1 --n, a Phone:
Address of Firm: '
'TYPE OF WORK:
Lay House Drain ; Repair House Drain
wM Lay Main Building-__
• Lay Lateral for Commercial/Industrial
s Building __ of acres
.�..�.
Connection will be made with i
Existing Water Supply: Public Water F Z Well
Proposed Start Date, mated time for completion
< ,WORK TO BE IN ACCORDANCE WIPH.TOWN OF SOUTH WINDSOR STANDARDS
ALL OSHA REQUIREMENTS AN�CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to -�ee the holder of Drain
t` Layer`s License No.
J . Only holders of Pj7aA6Y�S
-9 licenses
wii! be issued a permit. PERMIT WILL E3CPIRE THIRTY 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 CohnDOT Permit No.
PLEASE NOTE:
,« CBYD No. F f f Q 3FA SA/YITAR 6WER.L4TER4L
IS yi/ITHIN7SFiEET QFA WEXL
ITAdusrBfArR TESTED
Signed:
9 - ' Print Nameo �
n ed Drain Layer
Date: f
standard Forms\PermiwPPucATIoN FOR DRAIN LAYERS PERMIT.d(X
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOOATI.ON
DATE OF CONSTRUCTION: Jvvk 8 2ot�
BUILDING ADDRESS
STREET
SUBDIVISION: m5!0L� �V [tGCtCJti/ Wo9i-k
NORTH ARROW
APR _ ----- 31
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
sAllmoSC?g._ c27' fXoCXa'S /1 DATE
TOWN STATE ZIP INSPECTED BY TO
DATE
� - 28,_._._. . ._ -
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER