HomeMy WebLinkAboutDriveway Street Cut Permits 122 Pine Kno 700042
TOWN QF,SO.UTI-I W-IND-SOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 05/02/07 ;r>
GIS ID:72 000122
FEE`.
MUNIS APPLICATION# 2007005 % ` "` " " 25.00
85 EIRATION DATE:
{'> 05/01/08
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APPLIC :;:::;><::: :::ANT` �,
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NAME: BOUTIN&SONS .. X 121.PINE NOB DRIVEADDRESS: 121 WINDSORVILLE „BROAD BR
OOK,CT 0661"6
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SCRIPTION:SC RIP T IO N:
RIV
APPLIC
ANT
T AGR
EES
ST OF FU
RNISH
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THE TOWN OF SOUTH WIND """"� Q4•"T� 0 �OF��SQUIRED AND TO REIMBURSE
SOR FOR AN1':;E ENSIa I 7, ',: I C 1(7 .MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI `tPPIA1 ;F ;? rA ;: I ;ABIDE BY THE RULES AGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF` I l FT INY7 5 F12EE T'CLZ: ERAflT MANUAL.
ISSUED BY DA
EC`I ED INSPECTED BY
5/2/200711:21AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: f�D �- `
. . CONTRACTOR:_ Sou�/n
LOCATION:__ Ids ADDRESS:
TYPE OF WORK: vp
DATE INSP NEEDED: DATE INSP: /7 6
INSPECTED BY: Po D
WORK IN
PROGRESS: n;� Loos a!<
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INPUT: DATE: )
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APPLICATION FORSTREET EXCAVATION PERMIT
N OF SOUTH WINDSOR
PUBLIC- WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN. AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Boutin & Sons Const. Co. Phone No. 623-2526
Address of Firm 121 Windsorville Road roa rook, Conn 06016
Location of proposed work 1 2 P i n P Kn nh L)r i vP
Describe fully nature of permit requested complete dig out of to _ spa of driypwav strip the
red , add nrar.Pce Qrn 7P ,_grarle, rnl l nnri nave
Starting date 5-/1 5 n 7 Approx.time for completion_ 6 Z 1 5 0 7
Call before you dig no. 200 71703441 Traffic Services Control No.
Show sketch of proposed work or furnish TO be filled out by Town of SO Windsor
two copies of separate drawing Pavement Cut
Indicate Nortth. Prop.size of cut
No.cuts
s
2 q —7 / Amt.of Deposit S by
Cash O Check#
/ J Cut size after Perm. Patch
`n
0 f - - - - -- --- No.Cuts
Final Billing S
f /° 6 ' -
v Amt. Due Payee S
Amt.Due Town $
Applic t is responsible for contacting
the Po ce Dept.and C.B.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF
SOUTH WJNDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS
PERMIT AND THAT 1 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: Date:
Title: I- ✓ D.L.#
PERMIT SHALL BE KEPT ON JOSSITE AT ALL TIMES