HomeMy WebLinkAboutDrain Layers Permits 49 Lewis Drive 1700079 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 01/02/2018
1.GIS ID:53400049 �N a FEE: 80.00
MUNIS APPLICATION# 201701905EXPIRATION DATE: 02/0 1/2018
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APPLICANT LOCATION
NAME: SMART SERVICES ; - ADDRE4 LEVIS DRIVE
ADDRESS: 90 SNOWAPPLE L1�N> OWNER RIO }LUCILLE
MILFORD,CT 06460 `s 4 LEWIS DRIVE
PHONE S � SOU 1.1i WINDSOR,CT 06074
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WORK DESCRIPTION: NEW SECt0I"N-CTION
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THE DRAIN LAYER ASSIGNED TO THISTEIMIT ►S A 1D LICENSE ISSUED BY T'H STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR L IN TF °ATTACI PK WOND)'1111ONS ,: I FORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,AI.L OSFIf Ri:C1LTI.RI;MI-N!S AT�D FIB ATTACHED CONDITIONS.
IS UED DATE INSPECTED INSPECTED BY
1/2/2018 8:59 AM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: \ a C�: S&cl l Ie S'
LOCATION: H9 l '
TYPE OF WORK:_
DATE INSP NEEDED: DATE INSP: / r�
INSPECTED BY: t3»
WORK IN
PROGRESS: L ..� P w c- 5O r L 3:.>,-.
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES
AS-BUILT: '
INPUT: DATE: k o? • F
S/molloy/ibrms 2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT
FEE$80.00
Location of proposed work: 4 ewl 5 r` Lot#-
Street No. Street Name
Premises owned by:
Name of Firm: l�,�!�n —� ' Phone'.AO-?
Address of Firm: a n o dl r C T 240
TYPE OF WORK:.
Lay House Drain ; Repair House Drain '
Lay Lateral for building with connection '✓ : or no connection.
Lay Main ______,
Lay Lateral for Commercial/Industrial Building number of acres
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date 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 the holder of Drain
Layer's License No. 1- O' 5 6 . 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. 01 q 1 a0 q j PLEASE NOTE:
IF A SANITARY SEWER LATERAL
IS WITHIN 75 FEET OF A WELL
IT MUST BE AIR TESTED
Signed: Print Name: �1,"c
Licensed Drain Layer
Date: /A--I L/-i 7
Standard Fbr?nS\NMJtS\APPLICAn0N FOR DRAIN LAYERS PERMIT REVISION 2017.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: li
BUILDING ADDRESS : = y
STREET
SUBDIVISION:
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CONTRACTOR (PRINT) NAME OONT•RACTOR'S NPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
c o - I- "
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
Authorization Letter For Permit Application
Date: December 11,2017
Property Owner:
Address:
Address of Proposed Work:49 Lewis Dr.South Winsor,Ct 06074
To whom it may concern,
Per Public Act 91-95 this letter authorizes CZtL2-eL-6/cJto obtain and sign a permit
application from the Building Official on my behalf for the proposed address of work stated above.The
description of the job or proposed works is as follows:Replace water heater,reconfigure DWV and
water lines and install fixtures for laundry room,kitchen and bathrooms.
Start Date: December 1, 2017
Contractor: Michael Smith
License Number:#PLM.0283426-P1
Signature:��^�r
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