HomeMy WebLinkAboutDriveway Street Cut Permits 5 Carman Roa .. .
TOWN OF SOUTH WINDSOR INSPECTION REPORT
hermit No. 3767
Location 0005 CARMAN ROAD Contxaotor BOUTIN &:..-SONS
Type Work DRIVEWAY Address' 121 ROAD
ARRAD BRQOk GT 'O6016
Phone No 86
,..E 4).62:3�2'a26
Date Insp Needed
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Time Insp Needed
Inspected By
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Work in Progress C
Input Date
Permit No. 3767 Town of South Windsor, CT
Date 06/17/2004 Street Excavation Permit
Expiration Date 06/17/2005
Descrip:
Applicant
L eIt:'<ion
Name BOUTIN & SONS pQ(5 CPRMA9=ROAD
Addr. 121 WINDSORVILLEs' ROAD
BROAD BROOK CT 06016 y � b Wor; DRI TPy VAY
Phone (860)623-2526
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Applicant agrees to furti th the Town;;ctf eruth Win e 'mount of bond
required and to reimb rs� the. Town of South W3ntisor fps :any expenses
incurred by the Town >f'or ma nten rio o 'repa� wozk yn cortnectipn with this
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permit and that applicant zsi f mil'iar w th ncY tv�ll:;ah'd <`by th,e rules and
regulations for permlt;s as 'out WYt bf.'South'Windsor's Street
Cut Permit Manual.
* * PERMIT Tp BEyKEPZ ON 0 T."AL3 TIMES,
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Issued by — —
le
Date Completed
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
(� PUBLIC- WORDS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTHWINE2DS5.000R, CT
Boutin & Sons Const. Co. 623-2526
Name of Firm Phone No.
Address of Firm- 121 Windsorvii1e Road BroadBrook, Conn 06016
Location of proposed work 5 Carman Road
Describe fully nature of permit requested Stria Pxi cti nv riricra4,a� r,�,� t inTroraSS—Sr��g��
grade, roll and pave
Starting date Approx.time for completion
Call before you dig no. 20042403075 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No.Cuts
Final Billing$
Amt.Due Payee $
Amt.Due Town $
Applicant is responsible for contacting 01
the Police Dept.and C.B.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF
SOUTH WJNDSOR 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 6/14/04
Title: D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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ly
Quote Good for 60 s.Da ' • -
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Special Attention: 1/2 Payment Upon Starting, Balance Upon Completion.
Contract `,T� � Permit
i
ONE YEAR GUARANTEE ON WORKMANSHIP &MATERIALS.
CBUD 1`1i"�' V� U,� Date
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