HomeMy WebLinkAboutDriveway Street Cut Permits 343 Deming S TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4041 k•,:...:,,: ::..
Location 0343 DEMING STREET
C 'rector QUALYTy,,PAVING CO.
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Type Work DRIVEWAY
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Permit No. 4041 Town of South Windsor, CT
Date 07/21/2005
,,.,�4-'`�"""""""`�""'"""�-0• Street Excavation Permit
Expiration Date 07/21/2006 "yak
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5 4 PERMITS
Applicant f
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Name QUALITY PAVING jco. 3 DEMIN6�`.§TkZE,T ,
Addr. 194 S. MAIN STFE.E
EAST WINDSORT.,»A548g:M cs` :. r.
Phone (860)523-4182A.
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Applicant agrees`''t'd t;:urtii1;6 t the f`(:?bf:f1 h Wirii s;q` ? <^ he am? unt of bo
nd
and to re T.
orequired ex 6nses incurred by the To,4.n ,Jar sii Henan %$o x1 V I �.. 1
1.;". x"rnnect�on with this
permit and that appint zS � IR
Tim '"' .�a �ybyyie b�''.?the rules and
regulations for permits aspblsed' `
q0tAth ,Wi-hftor s Street
Cut Permit manual.
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* * PERMIT Tf3aYBE' IS.EP.T" :,: S`I9 ,'iPALI
Issued by d- -----
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Date Completed Inspected B
APPLICATION FOR STREET EXCAVATION PERMIT Vey/
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm 6� �� ��- Phone No.
Address of Firm
Location of proposed work
Describe fully nature of permit requested
Starting date joc)! Approx. time for completion .
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No.cuts
Est.Size of Perm. Patch(s)
t ` Est. Pvt.Thickness in.
�. Est. Unit Price$
I c�
Amt.of Deposit$
1 Total Due$ by
. ( )Cash( )Check#
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Permanent Patch
No. Cuts
`` Size of Patch(s)
r�I
Final Billing
Amt. Due Payee
Amt. Due Town
By
Applicant is responsible for contacting 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: AJ vll� Date:
o '5
Title: Driver's License#: � 7 fJs
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES