HomeMy WebLinkAboutReplace fire hydrant Street Cut Permits (3) 700156 TOWN OF SOUTH WINDSOR, CT
PERMIT-NiJMBER STREET CUT PERMIT
DATE: 10/02/07IJ
GIS ID:
47709999
FEE:
00
UNIS APPLI CATION# 200 701591
IRATION DAT
E: 10/0 1/08
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' OF SOUTH WI NDSORs:.ADDRESS: 125MAXIMROAD j;3 T
HARTFORD CT 06I14 " : i 54��H LIVAN AVE
S CT 74
PHONE
WORK DE
SCRIPTION: REPL,ACE': �•.:, RA T � . f, D :CORN N J FITCH BLVD
APPLICANT AGREES TO FURNISH THE T .'CI�$': F S .= A' ":,:``
4 ?H;' , .,,, IE AIYOTNTx Bf)ND REQUIRED AND TO REIMBURSE
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THE TOWN OF SOUTH WINDSOR FOR ANYkF,XP`ENSES, ICTJ ! Y.T, I-:OWN FOR'IVIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE PL1C NT.1 'PAM1 € "4VIT =1I WrLL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF 9' U.,TPT'W,1�P,'S S ,,,. tl" I HERMIT MANUAL.
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ISSUED BY JDATE INSPECTED INSPECTED BY
10/2/200710:31AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 7011 CONTRACTOR:
LOCATION:,5 lj
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: & D 3
INSPECTED BY: ,
WORK IN
PROGRESS:
AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
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APPLICATION FOR STREET EXCAVATION_PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.60
'Name of Firm , C .
Address of Firm S S .+ Phone No g F► ,.`�7 $' 7 SO
c -t
Location of proposed Work r•- ion
Jafnn i'-�1-� 13 J
Describe fully nature of permit requested
Starting date
Call Before You p No;�;(p0 Approx.Gme for completion g ,0 �p S
�7�•�i91 Z Trat>`ic Services Control No.
Showsketch of IxoPosed work or fumish
tivo Eopies of separate drawing Indicate North ThLs secf'ion to be tilled out by
Town of Snah-Windsor
LJOC)o Pavement Cut
No.cuts
Est'Size of perm.Patch(s)
Est Pvt Thickness
SsL Unit Price$ _
Arm.of Deposit$
Total Due 5 by
( )Cash( )Check#
Permanent Patch
61 V No. Cuts
Size of Pat *;)
Final Bilrng
Amt Due pa'y e -
AML Due room
• S -
APP
-
licant 1$re nsible for cordacu
ffie Police De t and
I AGREE TO FURNISH TO '[yE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO RF_fMSURSE THE
TOWN OF SOUTjj WINDSOR FOR ANy EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH T141S PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLINED IN THE:TOW OF SOUTH WINDSOR'S STREET CUf PERMIT MANUAL.
Signed• - '
Dater
Title__ ��( r
DrivePs License#;
PEPWI T SHALL BE KEPT ON JOBSITE AT ALC TIMES