HomeMy WebLinkAboutDriveway Street Cut Permits 320 Brookfie Permit, No. 3166
Dae 08/09/2001 Town of South Windsor C
Street Excavation Permit
Expiration Date 08/09/2002
Descrip:
Applicant
Name CUSTOM PAVING Location
Addr. JOHNF JURGELAS STREE
SOUTH WINDSOR CT 06074
Phone (860)528-2684 TYPE bf .Work DRIVEWAY
Applicant agrees tp furjnish, th�'Ttawrt if Bout
required and to re i mbOrse ,the Town 'of h `W i ndsor the amount of bond
incurred by the Town ¢or maifi t®nanc® t dreh$ �ri sO for any expenses
Permit and that app 1 i pant: s . ami l.i,<ar . rhpand � i 1 abide b
I
connection with this
regulations for permits a �utinc fin - jQ Towo
Cut Permit Manual . 11 Y the rules and
=south Windsor's Street
* * PERMIT TO 13E KEPT QN JbB BITE AT ALL TIME
Issued by �, ��A S•
Tit'.l�
Date Completed /7- I 2
6I
------- nspected By
TOWN OF SOUTH WINDSOR INSPECTION REPORT Z
Permit No.
3166
Location Contractor CUSTOM PAVING
Type Work DRIW Address JOHN F JURGELAS
VE
P.O. BOX 178
SOUTH WINDSOR CT 06074
Phone No. (860)528-2684
)ate Insp Needed
Date Insp. ' z b
'ime Insp Needed :
Time Insp :'
nspected By
ork in Progress
Input GV1,--. Date
4 APPLICATION FOR STREET EXCAVATION PERMIT J �
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No.
Address of Firm QW, P-7M
Location of proposed work ,
Describe fully nature of permit requested w h0aw.
Starting date l�S.g1� Approx.time for completion sr 4 yzz
Call Before You Dig No. Traffic Services Control No.
3 r7 coo[y '�► 4 a8
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ 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: Date: Lf
Title:— D D.L#•
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc