HomeMy WebLinkAboutDriveway Street Cut Permits 879 Avery St Permit No. 3648
- Date 03/17/2004 Town of South Windsor, CT
Street Excavation Permit
Expiration Date 03/17/2005
Descrip:
Applicant
Lbe::ation
Name BOUTIN & SONS
Addr. 121 WINDSORVILLE ROAD 4 R.Y. 57REET
BROAD BROOK CT 0606
Phone (860)623-2526 Type off` Woxk-.:DRIV8t7AY
Applicant agrees to:furhsh the:::fiowrt q required and to rei.mburse the Town �Suh WlricJs°r tI�e amount of
incurred b °f Sough Wzrttlsor f bond
y the Tows for mazntenati' any exPnses
Permit and that a Ce o reps work iri eonneGtlon with this
regulations for pPzlcant xs 'familiar wifih and will ; b .,b,
permits=' as outI e.d the rules and
Cut Permit Manuale T° of :South W..inds r
s Street
9
* * PERMIT TO BE 'KEP
T ON J SITE AT RLL .:�IMES :
Issued by --� 'Y1(l 0-1
Date Completed
i
• TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3648 '
Location 0879 AVERY STREET Cont.rac' or BOUTIN _SONS
Type Address: 121 WIND.SOR'UILLE ROAD
Work DRIVEWAY
$RQAD $RQOIC CT <06016
Phoxye623 z2.526':..
Date Insp Needed
------------- Date ,Insp � �,
Time Insp Needed
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me I*119*
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Inspected By
Work in Progress
---- 1
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Input Date
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR 3CQy
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
�^ c� m
Name of Firm 1 v Phone No.
Address of Firm
Location of proposed work � �
Describe fully nature of permit requested
Starting date Approx.time for completion
Call before you dig no. opnoZ �4 ;2= 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
No.cuts
,LogAmt. of Deposit S by
OCash OCheck#
i Cut size after Perm. Patch
No.Cuts
Final Billing S
Amt. Due Payee $
Amt. Due Town S
Applicant is responsible for contacting
— the Pc!ica Dept. and C.B.Y.D. by daie
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 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: C /5�
Title:— D.L.#
PERMIT SHALL BE KEPT ON JOSSITE AT ALL TIMES