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HomeMy WebLinkAboutWater Street Cut Permits 167 Ayers Road 2486 K yr y 08/24/1998 gyration Town of South Date 08/24j1999 Street Excavationdor, CT crip: WATER TIE-IN I Permit Applicant' ' ame CALDEIRA CONSTRUCTION ;' Location Addr. 6 BANFIELD LANE , BLOOM FIELD CT 060 Of 7 '"AYERS`aPOADPhone (860)2420 02; fiYAs Of W®rt WATER Applicant agrees required a t0 ir01 e}1 the and to reimbur$� Own -of incurred by the Town the._ own Gaut Windor the Permit and that for, of. c�uth W� dr .four amount of bond regulations for mit�lr+ na�tde ��� 1"$pa� �^ w applioant ". �mr. any expenses permits #t. +ork: {n<< connection Cut Permit Manual. ssoUl . h and: � 1l.. bide b with this line n th® Tows of � ©uth Y the rule,, and Windsor's Street * * PERMIT TO 13 KEPT O Issued by �, rr)) JO .YT ATEtfL, TIMES. `CEf�N A Date Completed T1 e � - tiernspected By TOWN OF SOUTH WINDSOR INSPECTION REPORT 'ermit No. 2486 .ocation 0167 AYERS ROAD Contractor CALDEIRA CONSTRUCTION YPe Work WATER Address 6 BANFIELD LANE BLOOMFIELD CT 06002 Phone-=No. (860)242-7017 ate Insp Needed off, GA L U$t gasp. ime Insp Needed ` '�irrte Insp. ;` ispected By rk in Progress 1 w Input Date mil / 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 a ( Ic I 1'CA- 0G Y,5 0 o - Phone r- -_7 Address of Firm !y Location of proposed work Vr + Describe fully nature of permit requested <° r— Starting date Approx.time for completion Call before you dig no. a 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 ,t ---hfd-ic`�e,North ` -- Prop.size of cut 4r� 6, 3,'v� = So. !6 � No.cuts { Amt. of Deposit S (50. 16 by f ()Cash H Check# _jt�105. i6 Cut size after Perm. Patch I No.Cuts IjFinal Billing S I - Q Z Amt. Due Payee S (rid zlr��� Amt. Due Town S '+ Applicant is responsible for contacting the Police Dept. and C.B.Y.D. i by date -- I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO RF,1MBURSE 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: < /k� '�- C fit. �'v` Date: L " Title: 0 }L. D.L.# PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES