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HomeMy WebLinkAboutWater Street Cut Permits 100 Cedar Avenu Permit No. 4115 Town of South Windsor, CT Date 10/24/2005 " Street Excavation Permit Expiration Date 10/24/2006 y Descrip: BUCKLAND RD CUT Applicant LOCat3dn Name FOLSOM CONSTRUCT%ON LLC 1i0 CEDAR AVD,. Addr. 138 RYE STREET SOUTH WINDSOR CT 060�4 Tyee © 'W6 DATER Phone (860)528-8928 Applicant agrees to f rnl li the Tozvri aid.it., Windsor the aiiIo�znt of bond required and to reiInlafitr e the Sowzx .'of South S+ ,- 'sor fob and expenses incurred by the Town r maante'nance Or' repair'work n snn ction with this permit and that appl .c&:nt IS :::£:a::>l3 :: ::. at_h aYzd .w� 1 aYSide by th'e rules and regulations for permits 0Utlineci :tTcStz.,'of SS.uE.Yi V.and 'or's Street Cut Permit Manual. * * PERMIT TO RB ICDI? ON �30D3 :$zZP AT ALL_:;-T M. Issued by ----------. . � atle'` Date Completed _ Inspected By TOWN OF SOUTH WINDSOR INSPECTION REPORT Permit No. 4115 Contra`dtor FOLSOM""C0.. STRUCTION LLC Location _ p.ddres 138 RYE 'STREE.� Type Work WPRa u�OUT�I WIND3$OR- C1. 06074 �� Phone No (86�}�528 :8928 ::. � .: Date Insp Needed Dates Sig 2i : . Time Insp Needed " TiDn�. IiSy Inspected By Work in Progress ------------------------- � ,_ ; ----------------------------- ----------------------------='_ � ---- Inpftt.;. ,W ...<:D'ate` APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR Permit No. PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00 Name of Firm F- ': : Phone No. Address of.Firm r L- i — " Q�J(o Location of proposed work !a o -e - r Deg be fully n ture of permit requested t Qa1cl, WX T f Sta ng date Approx. time for completion Call Before You Dig No. Traffic Services Control No. Show sketch of proposed work or furnish This section to be filled out by two copies of separate drawing Indicate North Town of South Windsor Pavement Cut No.cuts l l"Nf 0 Est.Size of Perm. Patch(s) , Est. Pvt.Thickness 8 in. Est. Unit Price$ 6'62 /— Amt.of Deposit$ 729 067 Total Due$ �%�. oCJ by ( )Cash(.Check# Ic s ` Permanent Patch No. Cuts Size of Patch(s) Final Billing Amt. Due Payee 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 PER AS OUTLIN THE TOWN OF SOUTH WINDSOR'S STREET CUT P RMIT "ANYAL. Signed: Igo Date: Title: Driver's License#: PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES TOWN OF SOUTH WINDSOR ENGINEERING DEPARTMENT ADDRESS PERMIT NO. SHEET OF UTILITIES INSPECTOR TEMP.PATCH DATE INSPECTOR COMPLETION DATE ITTT r ti t COMPUTATION SHEET