HomeMy WebLinkAboutTap 12 inch water main two locations Rye 700146 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/24/07
GIS ID:78600295
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FEE:
25.00
MUNIS APPL ICATION# 200701531 E PIRATION DATE:
09/23/08
AP
PLICANT I C ANT
O<I. CA TI O N
NAME: FOLSOM CONSTRUCTION L ,6,J. '.:: ">' `�D�'SRESS' ;;' 2+9 .7RYE STREET
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ASSOCIATES
ADDRESS: 138 RY
E ST
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SOUTH
WINDSOR,CT 06074>::
NE WBE RR Y RD
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PHONE
86 52 8-
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WOR
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CRIPTION:
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APPLICANTfE
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AGREES TO FURNISH THE TQWN OP: C1 }: '` OI '�' FO
THE TOWN OF SOUTH WINDSOR FOR ANC Ems?, :,NL3 REQUIRED AND TO REIMBURSE
C :;. OWN' MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THL:A 'I Ct I 'I,S'F I 1 Nla,j IT �YBME BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O 'SC i>WTNDB as> I i :CTjT.,.ERNIf'I;iVIANUAL.
ISSUED BY "" , •Y ~,
DATE<I1S:P.ECTET� PECTED BY
9/24/2007 2:59 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** 4 '
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APPLICATION FOR STREET EXCAVATION PERMIT �J
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
/ FEE $25.00
Name of Firm �s
1 Phone No.
Address of Firm
Location of proposed work ;
Describe fully nature of permit requested TG� // x- L 7 r
-------------------
Starting date_
Approx.time for completion_
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or famish
two copies of separate drawing indicate North This section to be filled out by
Town of South'Windsor
Pavement Cut
No.cuts
0 Est.Size of Penn.Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check# .
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
Amt.Due Town
° gY
Applicant is res nslble for contacti
the Police De t.and C.B.Y.D. Date
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 PERMITD AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLIN TOW OUT WINDSOR'S STREET CUT PERMIT MANUAL.
1
Signed:
�� Dater/ �� `� 0
Title._ d G� Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:_ j /.jr�
LOCATION:_
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 3-P
WORK IN
PROGRESS: 60
AS-BUILT:
INPUT: DATE: -
W/2007 Town of South Windsor INPSECTION REPORT 07