HomeMy WebLinkAboutDriveway Street Cut Permits 102 Colony R ♦♦ TOWN OF SOUTH WINDSOR INSPECTION REPORT
Pl4rmit No. 3701
Location 0102 COLONY ROAD Contyract>cs "' (fim :g; VSONS
Adi"ress.,; ?<;;<121 q�NI],SOR�T.ILLE ROAD
Type Work DRIVEWAY c;,
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Permit No. 3701 Town of South Windsor, CT
j Date 05/10/2004
»..4. ..•:,;,;. Street Excavation Permit
Expiration Date O5/10/2005
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Applicant
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Name OUT s.�€s B zl?>IN & SONS
Addr. 1
21 WINDSORVILLF' R.OAD.
BROAD BROOK CT 066"16
Phone (8 6 0)6 23-2 5 2 6iiF
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Applicant
c an t agrees?
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ttrzs, #the .' <
T" • �i Winc7pr>.ww:�''}�;e;'`amo�int of bon
required and to rei�nbur—' tf'e`.; a s: " '- k ': ':
;f ?r4sor e`er eases
incurred by the TowY fo` x.. !>s. . •' P
: siYnarra� .>l�• ;¢3P.ts< u:: ?
otanec't' p'n with this
permit and that applc.. ,#a §
:: .a�<ow1.., d«x:a:: ;^ . ce. the rules and
regulations for permits as '1. �t`• .• ``"''`'" "''€'"' ""' -
u 1 meal,': c< 3 '" '4 5 0 5ott ka'41 ndsbr's Street
Cut Permit Manual. s.r
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PER
MIT
Issued by
Date Completed � � "c-.:<.�....: r -- =--------
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---f---------- Inspecttee
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Arrl,IU iIIUN FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR ��®
PUBLIC WORKS DEPARTMENT
' TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WIrDSOR, CT
FEE 25.00
m
Name of Firm Boutin & Sons Const . Co. 623-2526
Phone No.
Address of Firm 121 WindsorVl e oa roa rook, Conn
Location of proposed work 10Q Oriy Oa
Describe fully nature of permit requested d lg ou eXls 1ng r1VeWay a grave ,
roll and pave
Starting date Approx.time for completion
Call before you dig no. Traffic Services Control No.
FShoo sketch of proposed work or furnish TO be filled OUt bV To,*" Of SO WIndSOr
opies of separate drawing Pavem t Cutdicate North
Prop.size of cut
No.cuts
Amt. of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No.Cuts
Final Billing S
Amt. Due Payee $
$
Applicant is responsible for contacting Amt.Due Town
the Police Dept.and C.S.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.
G Signed: i�•1 5/6/04
Date:
Title:
D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Job Location.
OFF ROUTE 5 STD. io
� Description:
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17 '
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ob
Quote Good for 60 Days.
Special Attention: 1/2 Payment Upon Starting, Balance Upon Completion.
Permit
Contract
. F
ONE YEAR GUARANTEE ON WORKMAnNSHIP &MATERIALS.
Date
CBUD