HomeMy WebLinkAboutDriveway Street Cut Permit 72 Ann Road Permit ,N„°• 3124
Date 06/01/2001 Town of South Windsor, CT
Expiration Date 06/01/2002 Street Excavation Permit
Descrip: CK#1354 FOR 4 PERMITS
Applicant
Name BOUTIN & SONS Location
Addr. 121 WINDSORVILLE ROAD,;; Qfl ANN ROAD
BROAD BROOK CT 0601�6
Phone (860)623-2526yRe off; Jprk pRIVEWAY
Applicant agrees t fur'nlsh the Town of „SQUt
required and to reimburse f `Town, Of �SoUth Windsor fQor the amount of bond
incurred by the Town forrenanGe car air r any expenses
Kermit and that a lic n is p Work in connection with this
regulations for pp t fami ' .w3 t#� .and °, _'� l abide by the rules and
permits asp op.tl in® ire tie .- .own,;ofi . South Windsor 's Street
Cut Permit Manual .
* * PERMIT TO BB KEPT QN JOB SITE AT
ALL TIMES. �
Issued by �T
— Ti tfie
Date Completed
Inspected By G�
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3124
Location o:Y; 11-, Contractor BOUTIN & SONS
Type Work DRVEWgY+ Address 121 WINDSORVILLE ROAD
BROAD BROOK CT 06016
Phone, No. (860)623-2526
)ate Insp Needed
Date_ Insp.
Time Insp Needed
T :me nsp.
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.nspected By
fork in Progress
Input. '_ Date - b
APPLICATION FOR STREET EXCAVATION PERMIT ]
TOWN OF SOUTH WINDSOR
PUBLIC- WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WIDSOR, CT
FEE $25.00
Name of Firm Boutin & Sons Const. C.O. Phone No. 623-2526
Address of Firm 121Winds_or_v_1 e oa-d TlroaCl. Brook, Conn
Location of proposed work 72 Ann Road
Describe fully nature of permit requested Strip driveway, dress with process grave
grade, roll and pave
Starting date Approx.time for completion
Call before you dig no. 20012201954 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 North Prop.size of cut
22 ,
No.cuts
I
p Amt. of Deposit $ by
t 'fit j f) Cash () Check#
Cut size after Perm. Patch
No. Cuts
/ 1
� I Final Billing S
I�
Amt. Due Payee $
Amt. Due Town S
Applicant is responsible for contacting
the Police Dept. and C.S.Y.D. by date
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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: Date: 5/3 1/0 1
Title: Secretary D.L.#
— PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES