HomeMy WebLinkAboutMiscellaneous Street Cut Permits 107 Cor TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4241
Coneactor ANDRE CHAF,BONNEAU & SONS
Location DR A:dres5 ;125 DW N ROAD
Type Work ISCELLAN :,SnUTR WINDSOR, C:T 06074
Date Insp Needed
Time Insp Needed
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Inspected By - die
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Permit No. 4241 Town of South Windsor, CT
Date 06/06/2006 Street Excavation Permit
Expiration Date 06/06/2007
Descrip: REPLACE CONCRETE S;I^DEWAK
Applicant Locat...
Name ANDRE CHARBONNEAV & SODTS OTiJT CORNERSLpNE £fR
Addr. 125 EDWIN ROAD
SOUTH WINDSOR jYe q 9Frv} ;MIsCEAN
Phone
Applicant agrees t'ti #Ux';1,4 :'the Town,Qf Cf h Windrxox tl e aTqotint of bond
required and to reitbti3'Yse the 'fox1 v &mouth W�rti3sear, ft7r ahy ex@rises
incurre
d b the Town::. eta �� ce ors"�'ep'a` 'Y"'oaor`]c :;:�;;ri�"� icrrine.ction with this
permit and that appli,c27t i.' 1`abide by the rules and
regulations for permits as:. c u.tIirie' r'' 7 s i 1 " vvk'' :€:off" $ :u' F `. d or.:; q i s s Street
Cut Permit Manual.
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* * PERMIT TO 'B$ iLEP� OTS 3 vZ�&>: i1 Af:S TIMFr$.
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Issued ✓'�P
Date Completed Inspected B
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm "�� -hy� �,,,
Phone
Address of Firm
Location of proposed work_ \ 6'"I
Describe fully nature of permit requested l i
Starting date ' ' Approx. time for completion '' `o
Call Before You Dig No. Traffic Services Control No. �
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South'Windsor
Pavement Cut
No.cuts
Est.Size of Perm.Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit$
Total Due$ by
( j Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
Amt. Due Town
By
Applicant is responsible for contacting
the Police Dept.and C.B.Y.D. ate
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_AN THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PER ITS AS OUT ED fE T OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
(� an,� - Date: a P Title: V�' v 1' r h' Drivers License#: V J 0
PERMIT SHALL BE KEPT ON JOB TE AT ALL TIMES