HomeMy WebLinkAboutDriveway Street Cut Permit 7 Ravine Road / TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3514 Cont:ra'Ctor CUS TOM=::PAVING
Location 0007 RAVINE ROAD Addres, JOHN F.ZURGELAS
Type Work DRIVEWAY P.O OXI 178
SOUTH WINDS.OR CT:.06074
Phone"Na 860)528-26,84
Date Insp Needed Date....Insp 3
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_ Time Ins i� r�M
Time Insp Needed
Inspected By ✓=3C_v_a�,C,�� c�CT�
Work in Progress _ Ksc- _� ` } Cr`1T�Sc2A
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Inp ut .— Date 7 � --
Permit No. 3514 Town of South Windsor, CT
Date 05/28/2003 Street Excavation Permit
Expiration Date 05/27/2004
Descrip:
Applicant Location
Name CUSTOM PAVING 00:07..RAVINE ROAD
Addr. JOHN F JURGELAS
SOUTH WINDSOR CT 06.074 Type of'Work DRIVEWAY
Phone (860)528-2684
Applicant agrees to :furnish the'Tovrn 'o£ South Windsor the. amount of bond
required and to reimburse the: Town mf Sout13 Vli'fidsor £or any expenses
incurred by the Town fo.r m.intenance or repair work in connection with this
permit and that applicant ar is famili w : 1t atxd'will'..abide bythe rules and
regulations for permits as outlined in the Town of 'South Windsor's Street
Cut Permit Manual.
* * PERMIT TO BE ;REPT ON J6:89 SITE AT ALL TIMES.
Issued by ____ fl—_ Title,:
Date Completed _________________ Inspected By _______________
• e?
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm S ?e
Phone No.
Address of Firm
Location of proposed work �7 4pA
Describe fully nature of permit requested 12t—t v
Starting date 7vi n r✓ Approx.time for completion e`
Call Before You Dig No. ,3 Gd a-fa ` Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
( )Cash ( )Check#
Cut size after Perm. Patch
No. Cuts
Final Billing $
Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting by 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: 1579 t l,t� Date:
Title: 42 Ai D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc