HomeMy WebLinkAboutMiscellaneous Street Cut Permits 155 Deb TOWN OF SOUTH WIND OR INSPECTION REPORT
Permit No. 2654 Contractor MARTIN LAVIERO CONTRACTORS
Location 0155 DEBBIE DRIVE Address 371 TERRYVILLE AVENUE
Type Work MISCELLAN BRISTOL CT 06010-4029
Ah9neNo. (860)589-7579
Date Insp Needed " ®.ate' Tnsp
Time Insp Needed Tirhe Tres .
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Inspected By
Work in Progress
0
Input Date
Perth.,it No. 2654 Town of South Windsor, CT
Date 04/15/1999 Street Excavation Permit
Expiration Date 04/14/2000
Descrip: CONCRETE RAISING/2 SLABS - SIDEWALK
Applicant Location
a
Name MARTIN LAVIERO CONTRACTOR �r �C�1a �� DEB$ DRIVE
Addr.. 371 TERRYVI LLE AVENI"E;`!
SRISTOL CT 06010-402 �` e off' rMTSCELLAN
_.....
Phone (860)589-7579
,
Applicant agrees to, furnisrv, thecwn* dffil `1dsor the amount of bond
required and to reimburse . o .p �Uth GVipr� fQr any expenses
incurred by the Town fo �m1�� �enand o w^ pai ^ i connection with this
permit and that app 1 i casLA. ,,,abide by the rules and
regulations for permits es1 �° �s4 a
� ,pf °South Windsor s Street
Cut Permit Manual .
* * FERMI Tb, B E D _Tt A .ALL TIMES.
I s s u e d by
Date Completed Inspected By ��
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm t V l�(s'� �1 l'c �l ►.��-a A-r Jn,phone No.—'NOD5-7 cR
Address of Firm 3-1k °'
Location of proposed work k ss-
Describe fully nature of permit requested ., `, ,,�
Starting date '-k Approx.time for completion it - it- -s a
Call Before You Dig No. 6.�Q 6aiceTraffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
St Pavement Cut /
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
()Cash ()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
SOUTH WINDSOR 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.
Signed: A, Date:
Title: e- !Z r- D.L.#:
PERMIT SHALL BE KEPT ON 308SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc