HomeMy WebLinkAboutElectric Street Cut Permits 450 Clark St 4, TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. Contractor DELRAY CONTRACTING INC .
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Location p . Address 9 LADE LANE
Type Work
ELLINGTON CT 06029
Phone No. (860 )870-8100
Date Insp Needed
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Time Insp Needed NitD M: 1NGGInspr,
Inspected By
Work in Progress
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Input C eA— -Date
A0rmiV N 3257 Town of South Windsor, CT
Date 03/20/200?_ Street Excavation Permit
Expiration Date 03/20/2003
Descrip: EXCAVATE TO INSTALL ELECTRIC CONDUIT-CLARK ST PUMP STA.
Applicant Location
Name DELRAY CONTRACTING INC. ,U43Q CLARK -STREET
Addr . 9 LAKE LANE
ELLINGTON CT 0602911 Tt?e" of W o,,ri< ELECTRIC
Phone (860)870-8100
Applicant agrees to "furnish "the" TOtn "bf" South "'Windsor the amount of bond
required and to reimbur`�5e ""the" Town:'of toU,th Windsor far any expenses
incurred by the Town for mal nilenance or ::r^epai r^ ",WdJt,k in connection with this
permit and that applicant s famJaiar wt F� and "will abide by the rules and
regulations for permits as Qia:tiin' in tie "Towry of South Windsor' s Street
Cut Permit Manual .
* * PERMIT TO,"SE iKEP7 .(�N J08 SITE' AT "`ALL TIMES.
Issued by
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Date Completed — -_ I nspected By
"41
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm i�-�12��-Z �'�-�jZ✓�C-TL•� Phone No. �
Address of Firm +- is t�z L cra �, r j M l_L I— C4--c2,,)
Location of proposed work C e 1,�a ✓Z/�
Describe fully nature of permit requested
Starting date % Zj Approx.time for completion `3Z 2'2-
Call Before You Dig No, -Zest, Z try(pu 4 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
/ Pavement Cut
Indicate North / (-��� J L Prop. size of cut `
No.cuts
I I _ Amt. of Deposit$ by
()Cash ( )Check#
Cut size after Perm. Patch
�i No. Cuts
Final Billing $
Amt. Due Payee$
4 V
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 TH/T-I AM'FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WIN OR'S STREET CUT PERMIT MANUAL.
Signed: `'' Date:
Title: 1 D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
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