HomeMy WebLinkAboutDriveway Street Cut Permits 343 Deming S (2) TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No, 4030 Gprit'ra�tpr: QUA&+I1A INI CO.
Location 03'43 DBMING STREET •:••>.
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Type Work DRIVEWAY � ,.3%... <., T� 'IREET
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Permit No. 4030 Town of South Windsor, CT
Date 07/08/2005 Street Excavation Permit
Expiration Date 07/08/2006 `s a'V
Descrip: CK 4626 - 2 PERMLTS
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Applicant Pli an t
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Name QUALITY PAVING ;to. ' w ::sss`<i'>
y,"E3 DEMING'>&:T. 1
Addr. 194 S. MAIN STREW >" s``^'
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EAST WINDSOR 08pe
Phone (860)523-418 µ :.:.:*.:.:::2
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Applicant cant agrees' ".:to': fi�ra?• 3s:'"�<;
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required and to relirFbll'Ys�li:." " Ta, f q Z ds r the :a'm°unt of bond
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incurred by the Totih., tlrritt2� ?ii: nane"ol'""r"e 'air"'wor.J>':i. >c'.onm; cton with
permit and that a l""',::* <>:x:„<:.:...- :': ;><r.! this
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regulations for °<:ab'i`tle,.>,by' ghe rules and
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ys%bk'"of::> uth`<I�nci'sor s Street
Cut Permit Manual. >;
* * PERMIT TO'$:BFe` PT"" If,....r ,ry' ""
�I:.S £'AT.3FIa? 'P'IN'ES.
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Date Completed _ Inspected By _
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm Q�K l�Y f ✓, .; Phone No.
Address of Firm
Location of proposed work
Describe fully nature of permit requested
Starting date Approx. time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish _This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No.cuts
0 Est. Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Pe w..n j $
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 O TLINE HE OWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES