HomeMy WebLinkAboutWater Street Cut Permits 56 Deerfield La r
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3926 > .
C�arf'tractgr WOQD;, COi3=�2UCTION
Location 0056 DEERFIELD LANE Tip " ";
Type Work WATER Ades 22TfOD GOAD,..
NtFR:S; CT'01071'>::;.
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Permit No. 3926 Town of South Windsor, CT
Date 04/08/2005 Street Excavation Permit
Expiration Date 04/08/2006 s r;
Descrip: REPLACE CURB BOX.:"' ' ~+' '
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Applicant
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Name WOOD CONSTRUCTLON•,; aks ,.
8br ERF .: Ib„"T'AIE'
Addr. 223
WOOD ROAD
SOME RS 7>CT 0 60 1
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e 860 7 6 3 4� 185
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Applicant a ree& ,tcas fu' s :;: '
g sysFr`''cf.,f�r�'' %>k,,.WinY:s �rd :>. he''amaunt of bond
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required and to reimburS t TopgEt� Ttp�orpx anyeazgenses
incurred by the Town ''f �X 1a,nto ,anc..++•;,`,`:f ,:.;. . ',., ":c nn t: on with this
permit and that appl' cant s'"€ataXsrsit<': gss''.t:s ' ' >a'<'.,jde'"b the rule a
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regulations for permits 's::.6u'tIind:` "" •`"` t "'.r :;:of,:5' ;ut.k' G7` ndsor's Street
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Cut Permit Manual.
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* * PERMIT TO+"BE E T 4Jid; JOB-SITE ;PiI`"'i 1L " T,FMES.
Issued b JC ; E�'
Date Completed ____ Inspected By
` `• "v~' ,v,Y r OWN OF SOUTHEXCAVATION
CAV TION PERMIT -# 3D-L6
Permit
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
-FEE $25.00 -
Name of Firm 'Ni ;J,
Address of Firm Z phone No SL(� � ,'�- y c�
W c< ►�o S c rn 2. r
Location of proposed work_
Describe fully nature of permit requeste-' i2 IzIl„y z \NIA cL
Starting date_ L2T- ,
Call Before You Dig No. "Zoo , p ZZ Approx.time for completion_ Z Nc,vz�
Traffic Services Control No. N�,
Show sketch of proposed work or furnish
two copies of separate drawing Indicate NorthFPvt.
on to be filled out by
of South fNndsor
t
—
rm.Patch(s)ness in.
Est.Unit Price$
' Amt.of Deposit$
I C Oi??EK warCK
Total Due$ by
( )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. Date
1 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 F
PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. OR
Signed: -j ( (" �
�] Date:_ -A PaR i L Zooms_
Title:_ i R0 , M 6
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES