HomeMy WebLinkAboutDriveway Street Cut Permits 24 Devonshir 700177 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/22/07 " .,. 3-'"'
GIS ID:27900024 FEE: 25.00
MUNIS APPLICATION# 20070172 yr->.:.:'' « :5 TION DATE>- ' A 10/21/08
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APPLI A C NT:
LOCATION
NAME: BOIVIN CONSTRUCTION INCU:.]
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ADDRESS: 109 RT 6
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COLUMBIA CT 0623
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RK DESCRIPTIO
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APPLICANT AGREES TO FURNISH THE TN 3F TIL W , y MOLI'NT:OF 9:0
C3W REQUIRED AND TO REIMBURSE
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THE TOWN OF SOUTH WINDSOR FOR ANI'' XPE FINC jZ FflfMyTNTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE 1 P-ROANT'-FS.FA�I II �A.: IH`ANIJ'V LI`ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SQZ7T pS1 'S"STIZ ET Uf P-P 'IT MANUAL.
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ISSUED BY DATE INSPECTED INSPECTED BY
10/22/20072:33PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: `1 00 %'] '
_ CONTRACTOR:_ C 1 \) 1 N)
LOCATION: 0 h'�c _.._..._ _._
TYPE OF WORK:
------------
DATE INSP NEEDED: DATE INSP: !AL
INSPECTED BY:
WORK IN
PROGRESS: �r� j &„%
AS-BUILT:
INPUT: ( " DATE: ` q _c�>
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATIOlIV,FOR STREET EXtA�ATION PERMIT
TOWN OF SOUTH WINDSOR
r PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORf CT
/� FEE $25.00
Name of Firm Ln Phone o.
Address of Firm
cation of pro ed work
Describe
Ily nature of permit requested
Starting date "1 Ap x.time for completi
Call Before You Did N Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor I
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts
Amt. of Deposit$ by
i O Cash O Check# J
Cut size after Perm. Patch I
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town $
Applicant is responsible for contacting by date
the Police De t. and C.B.Y.D.
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT BOND REQUIRED AND TO REIMBURSE THE TOWN OF
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTEN CE 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 WINDSORAS STREET CUT PERMIT MANUAL.
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Sig ed: Date: / U
Title:
D.L.#:
POAMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permlt.doc
109 Raute 6•Columbia,CT 06237 OTT
JOB ESTI AT
, 1-800-PAVE-145.228-4030 O
® Date of Es
spared by: '`pr
bowin construction -
Job Addre
Job Phone: WAAcPhone: *. _
Pr osal Num er: Type of Job: Sq.
ESTIMATE
FOR:
Specifications:
Fine grade existing base adding processed stone asT(oi
❑ other
Pave u g hest beU.�rninti�us as�a;;ait as follows: �
_ -..
V2."binder ss 2 �.
—V"M)L�L' f
S ecial otes: 1
ue
Estimated Completion
State Permit Required: ❑ yes o
Town,Permit Required: es no
Taxable: r'
o
Estimate Approved by.
Total
Signature for Quotation Release:
-materials ..
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