HomeMy WebLinkAboutDriveway Street Cut Permits 15 Beelzebub Permit No. 3585
Date 09/05/2003 Town of South Windsor, CT
Street Excavation Permit
Expiration Date 09/04/2004
Descrip:
Applicant
Location
Name QUALITY PAVING CO.
Addr. 90 STRONG ROAD OOIa� BEI<ZEBTJB ROAD}
SOUTH WINDSOR CT 06074
Phone (860)523-4182 Type r3 ._ WorkDRIVEWAY
Applicant agrees to: fur"sh the:`Town of South WimsoY the amount of bond
required and to reimburse the Town o£ So:uth Windsor for and expenses
incurred by the Town for maintenance or rapair work in connectidn with this
permit and that applicant is familiar with and. will abid6 regulations for permits by the rules and
as ot:tline.d �n the Tows of S:csuth Windsor Cut Permit Manual. » . s Street.
* * PERMIT TO BE:KEPT ON SOBTTF,.AT ALL„TIMES.s
�!''•�'" .ter'
Issued by
---- Tit 1 e
Date Completed
----------------- Inspected By
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3585 Contra:ctor QLTALITY:.;,PAVING CO.
Location 0015 BEELZEBUB ROAD ACZdress' 90 STRONG ROAD
Type Work DRIVEWAY SOUTH W°INDSORT 06074
Phone No ($60..)523.-'4::182
Date Insp Needed --�` D"ate Insp s
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Time Insp Needed — -- Time Tp L1
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77
Inspected By �� �
f - - -
Work in Progress c
Input _ — .:Date ----- _—=�—
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm ��Z.a? -' Phone o.____
Address of Firm
Location of proposed work 4-1
Describe fully nature of permit requested
Starting date Approx. time for completion
Call Before You Dig No. 2003 `C /9 3C, Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No.cuts
Est.Size of Perm. Patch(s)
I Est. Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$
ITotal Due$ by
( )Cash( )Check#
t� Permanent Patch
� No. Cuts
CSize of Patch(s)
Final Billing
Amt. Due Payee
( f
2 Amt. Due Town
$
By
Applicant is responsible for contacting Date
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 PERMIT MANUAL.
Si 9 ned: l � G C2/LC Date:
Title: Driver's License#: /
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES