HomeMy WebLinkAboutWater Street Cut Permits 64 Barber Hill 700205 TOWN OF SOUTH WINDSOR, CT
PERVIT NUMBER STREET CUT PERMIT
DATE: 12/05/07 `
GIS ID: 07800064 ;, 4: `,
,: FEE: 25.00
MUNIS APPLICATION# 200701975 'h'''
,RATION DATE: 12/04/08
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APPLICANT.i 4. LOCATION
NAME: DUSIK CONSTRUCTIQN . ;<''.f'.'.> r'
aRES '4ARBEI HILL ROAD
ADDRESS: 20 PHEASANT WAY
SOUTH WINDSOR
CT . 74TREET.. *I -A
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{'< €3R O' CT 06110
PHONE 860-490-8468
WORK E D SCRIPTION• WATER.. ma-
APPLICANT AGREES TO FURNISH THE TaWNSF 3 iTH::: .`'.<:' •.' '' MO "O.F'BI7N: REQUIRED C ,,. ,.,. 1 N QU RED AND TO REIMBURSE
THE TOWN OF SOUTH WIND SOR FOR ANAV6kNtSttS 1N t "R u 40"F0MNI, INTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE kPP'I f 1N 1' A1vII. AR< 'I "AND�LL`'ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF St)3JT T I SR;S`ST1 I,T QU-3 `�32IYII'1 MANUAL.
ISSUED BY I DATE INSPECTED INSPECTED BY
12/5/200712:06PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 7 00 d-0S—
CONTRACTOR:_
LOCATION:_
TYPE OF WORK: ate _
DATE INSP NEEDED: DATE INSP: lz o7
INSPECTED BY:
WORK IN
PROGRESS:_ ( �r107a C r l�?4 c� c� :3 �� ,( 5',�,
AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR.STREET EXCAVATION.PERMIT 70D- -
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE-$25.00 -
Name of Firm t LtS
can L�Address of Firm Phone No. @�O - LIQj y^ 1-1600
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6 (��►-e 4.,5 a,��4•• W •
Looation"of proposed worker aalr -r .74 ti 1A J-
Des 'be fully nature of permit requested
Starting date /-P- v? ox:time for
Appr comPI etion
N
Cali Before You Dig Nox�l a 19 Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
• Town of:South'Windsor
Pavement Cut
u No.cuts
Est.•Size of Penn.PaWs)
Est.PvEThickness %-., in.
0 a Est.Unit Price$—r
of Deposit
Ll
Tote!Due a _ S. by
t12�tiJ . r�r`?cte
( )Cash( )Check#%
Permanent Patch, s
- � S -- ---------- No. cuts .
Size of Patq(s)
3 Final Billing
Amt.Due Payee
Amt Due Town
Applicant is re n taco
the Police Dept.-an! C.B.Y.D. -
AGREE TO FURNISH 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 JPOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WI THI RMIT AN0 THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS O N IN E TOW OF SOUTH WINDSOR'S STREET.CUT PERMIT MANUAL.
Signed-
Title: Driver's License#: !7,?7 71 O L
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES