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HomeMy WebLinkAboutMiscellaneous Street Cut Permits 12 Darl TOWN OF SOUTH WINDSOR INSPECTION REPORT Permit No. 3027 Contractor HOMEOWNER Location 0012 DARLENE DRIVE Address SAME AS ABOVE Type Work MISCELLAN SAME AS ABOVE SOUTH WINDSOR CT 06074 Ph`'c ne No.. (000)000-0000 Date Insp Needed ' Date Insp._ _ 8�3t Time Insp Needed Tifne Insp. 3% 0 Inspected By 'q. Work in Progress Input Date Permit- No. 3027 Town of South Windsor, CT Da-to 09/12/2000 Street Excavation Permit Expiration Date 09/12/2001 Descrip: SIDEWALK REPAIR Applicant Location Name HOMEOWNER 0. � ©ARLENE DRIVE Addr. SAME AS ABOVE SOUTH WINDSOR CT 06Q74 .. , T � of Wq��k. MISCELLAN Phone (000)000-0000 T Applicant agrs wor the amount of bond required and to ftimb h �V1 11 ,E 0r for any expenses incurred by the Town 1=ca - titien'anecr� re pa ii connection with this pe rmi t and that app 1 c�it �, f, � and a�itil _,ab i de by the rules and regulations for permits.A,asi,Wtlatl a; t ;�°can°, pf,-South Windsor's Street Cut Permit Manual . * ERMIT T KEPT SITS 'AT", LL TIMES. Issued by " itle ��,a, Date Comple a -� Inspected Y APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT , FEE $25.00 Name of Firm MA Lt u t� uy W,I-S Phone No. 6 gAe7a Address of Firm I Z. Location of proposed work yZ a r r< s Describe fully nature of permit requested Starting date --� _Approx.time for completion Call Before You Dig o Traffic Services Control No. Show sketch of proposed work or furnish To be fi'?ed'Out by Town of South Windsor two copies of separate drawing Pavement Cut Indi to North Prop.size of cut No.cuts Amt.of Deposit$ 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 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 f SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND THAT I AM FAMILIAR WITM AND WILL ABIDE BY THE RULES AND REGULAT ONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR S STREET CUT PERMIT MANUAL. Signed: / ram Date: G U Title: PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Standard Forms\Permits\Street Excavation Permit.doc TOWN OF SOUTH WINDSOR INSPECTION REPORT PROJECT: SIA'B(AAU - )NSr'Ct1ot,) DEVELOPER: STREET: 'Z l CONTRACTOR: DATE: HUC�iJS' 31 ,Z.oa�t2 TIME: 3 0 WEATHER: SuryG/ WARµ INSP: WORK IN PROGRESS: C; y ALL- ;a i A —frCgA'( vV- PACGI'A.* v 4 (&OLS ok. t,CPt 2�11n tiOr 5SEXTZ- �b�J ConKR `rt ayLD &e . AREA OF CONCERN: SPECIAL INSTRUCTIONS: