HomeMy WebLinkAboutDriveway Street Cut Permits 18 Carey Lan TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3959
Co,..nt'ractor QUA,LIt`Y';,p,AVING CO.
Location 0018 CAREY LANE
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Type Work DRIVEWAY :.:.
E.A T. WrftSQR «C 06088
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Permit No. 3959 Town of South Windsor, CT
Date 05/03/2005 a"< Street Excavation Permit
Expiration Date 05/03/2006 e>
Descrip: DRIVEWAY REPLACEMENT '
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Applicant
Name QUALITY PAVING CO. " 8 CAREY
Addr. 194 S. MAIN STAE T.• <` `r
EAST WINDSOR CT .6(#88 r �°P e ptO1�t.DRVWAy
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Phone (860)523-4182 <,
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Applicant agrees ttq:; ?
lf�th WiriSxF.x +thyamount of bond
required and to re 116bff sel, t Tc 7q y gQi tT 3 axdsor o any xpenses
incurred b the TO4*%
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z'h. narlc@""o'r"`"�'ep'ai'��' ti�oxJ�'`.;i; #'s�c,dn�;ect.ion with this
ermi t and r< 'ak•,.. .::�;: :>?:::<:: :;::::;,::;r<::.....::::.
P that aPP :int+` ":' ' ris` '=a �
Wi3:.1=:�b3;de:>,by' �'he rules and
regulations for permits a:SCe'< f'"`'ofouh`?:bIinc'sor s Street
Cut Permit Manual.
PERMIT TO BE'`XtR-T';, ALL.....TI. S.
Issued by -e 4
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Date Completed Inspected B
APPLICATION FOR STREET EXCAVATION PERMIT
" TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm ( � �z �� Phone No.
Address of Firm
Location of proposed work
—01
Describe fully nature of permit request
St Wing date 6 0 Approx.time for completion
Call Before You Dig No. Traffic Services Control No.-
/90 /'Z 7
Show sketch of proposed work or furnish s se
two copies of separate drawing Indicate North ThITow of South Wi dsor bor
Pavement Cut
No.cuts
Est.Size of Perm.Patch(s)
Est Pvt Thickness in.
Est.Unit Price$
( ( Amt.of Deposit$
f
�,... / Total Due$ by
Cash( )Check#
( Permanent Patch
c� �c No. Cuts
Size of Patch(s)
Final Billing
$
Amt.Due Payee
a
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
PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Oy Q
Date:
Title: Drivel's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES