HomeMy WebLinkAboutDriveway Street Cut Permits 20 Blue Ridg Permit No. 3739 Town of South Windsor, CT
Date 05/26/2004 Street Excavation Permit
Expiration Date 05/28/2005
Descrip:
Applicant Loot:
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Name BOUTIN & SONS Ob�tT BLUE RIDGE p ME
Addr. 121 WINDSORVILLEROAD .,.:.
BROAD BROOK CT 06016 Type a .Work pRjVEWAY
Phone (860)623-2526
Applicant agreed ta. furn..ft the;Town of South Wiids x- the atttoxnt of bond
required and to reimbursO the Town of South W dsor for any expenses
incurred by the Town fQr mantenaxe t7 -repaai :work in ectnnec!tiQn with this
permit and that applicant is f�mill& .wa.Zli anel 41 :ab de `by the? rules and
regulations for permit ; as outlined 1u tie Tgvyn eaf S.rsuth. 'Windsor's Street
Cut Permit Manual.
* * PERMIT TO BE;::KEPT 'ttiN �QB;SIT _A ALL` TIMES.
Issued by ----------- ell Tit 1 e.,
Date Completed
p ----------------- -::.;:..;:..::_;:.,:I r?S.,p:p.ct ed. By
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3739 Cont;radtor BOUTT1 &.:;,.SONS
Location o026
Addres 121 WIN:DSORV,TLLE ROAD
Type Work DRIVEWAY B:RQAD BROOK CT 6016
Phone No E86Q)623'2526
Date Insp Needed ------------- — Date Ix3sp
— — —
Time Insp Needed x y�
-----—------ Time TstS}r (�
Inspected By
Work in Progress — j
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input., Date
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC TOWN DEPARTMENT
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Phone No.Name of Firm
Boutin & Sons Const . Co. 623-2526
AddressofFirm 121 Windsorville Road Broad Brook, Conn 06016
Location of proposed work ue Ridge Drive
Describe fully nature of permit requested dig out and strip e X i S i n g drtveway, add gravet,
grade, roll an pave
Starting date Approx.time for completion
Call before you dig no. 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
j
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit S by
O Cash O Check#
Cut size after Perm. Patch
No.Cuts
Final Billing S
Amt. Due Payee $
Amt. Due Town $
Applicant is responsible for contacting
the Police Dept. and C.B.Y.D. by date
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.
sus 5/27/04
Signed: '/ Date:
Title: �C- Gre, T i ' D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Quote Good for 60 Days.
Special Attention: 1/2 Payment pon Starting, Balance Upon Completion.
j Contract Permit
ONE YEAR GUARANTEE ON WORKMANSHIP.& MATE IALS. C, p `
CBUD
Date
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