HomeMy WebLinkAboutConnect water main Street Cut Permit 165 TOWN OF SOUTH WINDSOR INSPECTION REPORT
• Permit No. 3527 Contra et..MID'`STkTE SITE DEV.
Location 0165 ABBE ROAD Address.: .; :(P.O,:.>BQK. 65`4=
Type Work WATER CANT6N 'CT:06019=:::._
Phone V6 (8fi<4)693-6899
Date Insp Needed ---------- Date I:nsp �3 _
Time Insp Needed _ _ 99'T1me
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Inspected Bykv
Work in ProgressLL
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input ...---- Date
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Permit No. 3527 Town of South Windsor, CT
Date 06/16/2003 �. .., Street Excavation Permit
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Expiration Date 06/15/2004
Descrip: AHERN LOT 2
Applicant Locatiax�
Blil;Jll :cX
Name MID STATE E DEV. 01.6 ABBE ROTA-
Addr. P.O. 654
TON CT 06019 Tjrpe of T�Ior WATER
P e (860)693-6899
Applicant agrees to ::furn�s:ki'thedWn eif South Windsor tide at4iount of bond
required and to reiYnbur.se the.,.Towxt f South w1hasor.fer ani expe%nses
incurred by the Town fog ma�sPtenance or repair work in con tion with this
permit and that applicant xs famili' r Wi11 artd wia 11 abade ..by tl'e rules and
regulations for permits as outlined; *'t Clxe Iawz of South Wd,.ndpor's Street
Cut Permit Manual.
* * PERMIT TO BE ;KEPT ON COB SIT—-XiT ALL.,. I,MEIS.
Issued by __ 'Title
--- -- — --
Date Completed _________________ Inspected B
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm vw iBn ,Phone No. �f �3� /S`�
Address of Firm , / ee— f dp
Location of proposed work 6&r6
Describe fully nature of permit requested ! in!
Starting date—"/ 15 Approx.time for completion 19,00
Call Before You Dig No. 00 2 O Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
IndicYaltee North Prop.size of cut
c No.cuts 1Z x S =-?YO
1
t Amt.of Deposit$ mo. PO by
t
- O Cash of Check#
Cut size after Perm. Patch
No. Cuts B
w
Final Billing$ O
Amt. Due Payee$ -z-fa.®O
Amt. Due Town$
Applicant is responsible for contacting by i Zv P-'—e date 2j e. e
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 P MIT MANUAL.
Signed: t C/3
n / Date:
Title: �/f�l t.� Lam.y'�1/ D.L.#: ZE0Ae7
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc