HomeMy WebLinkAboutDriveway Street Cut Permits 151 Buckland (2) TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 3747 Cont:rattor FOLSOM' C-ONSTRUCTION LLC
Location 0151 BUCKLAND ROAD
Addrei 138: RYE,^<:STR'ET
Type Work DRIVEWAY SO?J,TH W'IN2J6OR ''�:!P 06074
Fhope No, (864)528 8:9,28
Date Insp Needed /` C
7.
Time Insp Needed
Inspected By
Work in Progress ✓�' fG ?ay '�
77
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Input Date ---
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Permit No. 3747 Town of South Windsor, CT
' Date 06/04/2004 Street Excavation Permit
Expiration Date 06/04/2005
Descrip: TAMARACK DRIVEWAY 'FOR EI •
Applicant Iacdtsan
Name FOLSOM CONSTRUCT''ION ,BUCKLANJ: RLl$D
Addr. 138 RYE STREET
SOUTH WINDSOR Cfi a6074 Ts 'of Wt5'xk DRIVEWAY
Phone (860)528-8928
Applicant agrees, to furnish the ovnsf Sough Windsor the]:: : mcxunt of bond
required and to relm urse s:thg owt off, :South rt l r fox'"arty exp,nses
incurred by the Town, for M,as Mt ance or repair word lt1 annetion with this
permit and that applicant is f;aiilia ,cybd w>11 akPcle.by the rules and
regulations for permits as dU t:l;ined the down o.f South Wsxid:sor's Street
Cut Permit Manual.
* * PERMIT TO'"'BE K$'P;T,ON`J'OB SI3 ` AT::.::AI :;:;.TIMES.
Issued byTitleJ`a7 � ��`y..� O�/
Date Completed _ Inspected By -� � 1
rirr�.t�.Ht iUly t-UK STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
a TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm . 0
DM d G /
Phone No.
Address of Firm ,L �
Location of proposed work
Describe fully nature of permit requested
Starting date v
Approx.time for completion
Call Before You Dig No. -0 Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South Windsor
Pavement Cut
^ ( No:cuts
Est.S' a of. ui Perm.Patch(s)
Est.PvL Thickness in.
Est.Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
-Permanent Patch .
No. Cuts
Size of Patch(s)
Final Billing .
Amt.Due Payee
Amt.Due Town
\ By
Applicant is responsible for contacting
the Police Dept.and C.B.Y.D. Date
II AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT
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
I PERMITS AS OUTLINED IN THE. OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
w F
,Signed: Date:
itle: Driver's License#: d`►,� �b Q
ERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
I