HomeMy WebLinkAboutDriveway Street Cut Permits 240 Brookfie Permit No. 31V
Date 08/09/2001 Town of South Windsor, CT
Street Excavation Permit
Expirati' n Date 08/09/2002
Descrip:
Applicant
Location
Name CUSTOM PAVING 4244 �ROOKFIELD STREE
Addr. JOHN F JURGELAS
SOUTH WINDSOR CT 06074 ,, �Y
Phone (860)528-2684 oWork DRIVEWAY
t
Applicant agrees to,
o furh_i sh:`the `Yawn of 'South, Windsor the amount of
required and to reimbrs „ h Tw � ? Sth :W i $ r for any expenses bond
incurred by the Town fprnaintnanei +rrepa7 r �tr k i► connection with this
'
Permit and that app 1 i cant s f4mi I for 41 th and-: ' � 1.1 abide by the rules and
regulations for permits as lined inf #�� Town, of South Windsor's Street
Cut Permit Manual ,
* * PERMIT `TO 8E' KEP7 bN SITE AT ALL TIMES.
Issued by �C(Z1JR Tit'1a "7r r
Date Completed
Inspected By
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3167 Contractor CUSTOM PAVING
Location s, Address JOHN F JURGELAS
Type Work DRIVEWAY P.O. BOX 178
SOUTH WINDSOR CT 06074
Phone No. (860)528-2)684
Date Insp Needed `: ;Da-te 'Insp..
Time Insp Needed Tta,,Insp.`
Inspected BY
Work in Progress
Input,". ��"�� Date
• APPLICATION FOR STREET E T EXCAVATION PERMIT �}TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm C S �� Or�1 t/ Phone No. ti
Address of Firm 1'7
Location of proposed work Q 1-1 r G �.• : e a
Describe fully nature of permit requested
Starting date _A Approx.time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.aft
"Amt.of Deposit$ by
O Cash()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting by 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
Signed: 94� Qrti. Date: /Q
Title: 77�> E2 on D.L#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc