HomeMy WebLinkAboutDrain Layers Permit Strong Road - Bailey TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit I. 53 Contraotor DOUBLE-C.CONSTRUCTION LLC
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Location tea, AtldresS P O BOX:.:785-45 EVANS RD
Type Work SAN MAIN R.O.CKY HILL CT 0::6067
Date Insp Needed Date Insp
Time Insp Needed -----------� __- Time T
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Inspected By -
Work in Progress
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Input Date ----�(i �C 11 -
Permit No. 3653 Town of South Windsor, CT
Date 03/31/2004 Street Excavation Permit
Expiration Date 03/31/2005
Descrip:
Applicant Location
Name DOUBLE C CONSTRUCTION ZLC SHADYHROOK
Addr. P 0 BOX 785 45 EVANS _RD;,
ROCKY HILL CT 06067 : T p.e of .Work-SAID I AIN
Phone
Applicant agrees to -f ti'a,is_h; the Town-.e5f: South Windsor'the .7mdunt of bond
required and to reimburse tli .Towm o;f South W�nd'Sor for any`expenses
incurred by the Town for ma�r�.tenance or repair work -iij connection with this
permit and that applicant is fatAi3$a with �a.A will abide by the rules and
regulations for permits as out ined1;j tkze Town- of SOuCh_Td .ridsor's Street
Cut Permit Manual.
* * PERMIT TO BE KEPT ON �OB:.$ITE' AT: AIL::TIMES.
Issued by v� �`/ �_�✓___LlJ _ - Tit 1 ei u-. t`^5,%�P 2/
Date Completed _________________ Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT j(c -5'
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm__ _cl Ph
C 7
one No.
Address of Firm `)
Location of proposed work
Describe fully nature of permit requested
Starting date Ic" s 6
4 Approx. time for completion f �(
Call Before You Dig l 0i Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South Windsor
Pavement Cut
No.cuts_ 1�))*
Est. Size of Perm. Patch(s)
Est. Pvt. ,—
Thickness in.
Est. Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
["�" II ( l — -— Permanent Patch
f �4l`\ No. Cuts_ ^�
Size of Patch(s)
rFinal Billing
Amt. Due Payee
e•c. C li.{ J;�-`�- + 13c�ti11y C�.-c Amt. Due Town
By
Applicant is responsible for contacting Date
the Police Dept.and C.B.Y.D.
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:_,lML/' 'f/� Date` 64
1
Title: (j OL{ Driver's License#: I�1� I ..J
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES