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HomeMy WebLinkAboutDriveway Street Cut Permits 40 Brian Roa Permit No. 3738 Town of South Windsor, CT ' Date 05/28/2004 Street Excavation Permit Expiration Date 05/28/2005 Descrip: Applicant Ldcatatln Name BOUTIN & SONS OQ'4b BRIAN RgAA Addr. 121 WINDSORVILLB ROAD BROAD BROOK CT 06(1,16 Type tzf- 14ok ARIVBW Y Phone (860)623-2526 Applicant agrees to'""ft�rYrYS:h. the Town o;£ Sout`h Wincls�r tkie amount of bond required and to reimbu.r'.se the, TotVxi :Csf r�u h Yi rit3sor„ E€>r ary 'e;r enses incurred by the Town f:or ma.an't nano or 'rep air"work in Csrin�ection with this permit and that apply ca'rit 'IS ,, 7=aT th x d;'wz l abzde ley t...e rules and regulations for permits as oiztlaned: i# the TAW "of South W.i,rxd or's Street Cut Permit Manual. * * PERMIT TO -BE..k:F,T On JQB Issued by ......... _►/ Title , Date Completed Inspected By 11A . x TOWN OF SOUTH WINDSOR INSPECTION REPORT lermit No. 3738 Contractor BOUTIN"& ..SONS Location 0040 BRIAN ROAD .Address 121 NTII)NDSORVILLE ROAD Type Work DRIVEWAY BROAD BROOK CT ©;6016 Phone 'No M 0)623..` 526 Date Insp Needed ----------- rlat2 ?<nip Time Insp Needed ____________ Time Insp Inspected By y Work in Progress ( ------------------------------ — —. Input {-�"' w Date — — APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm Boutin & Sons Const . Co. phone No. 623-2526 Address of Firm 121 windsorvi l le Road Broad Brook Conn 06016 Location of proposed work 40 Brian Road Describe fully nature of permit requested_ dig out existing driveway, add gravel-, grade. roll and pave Starting date Approx.time for completion Call before you dig no. 20042202740 Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town of So Windsor two copies of separate drawing, Pavement Cut Indicate North Prop.size of cut No.cuts Amt. of Deposit$ by O Cash O Check# Cut size after Perm. Patch No.Cuts Final Billing$ 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. Signed: Date: 5/2 7/0 4 Title: �� �i/'E'��!v/ D.L.# PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Description: T Quote Good for 60 Days. j Special Attention: 1/2 Payment Upon arting, Balance Upon Completion. (, C� Contract Permit ONE YEAR GUARANTEE ON WORKMANSHIP&MATE ALS. CBUD Date s ;S cF,