HomeMy WebLinkAboutWater Street Cut Permits 89 Edgewood Dri t TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3462 Contractor M.J . D. CONSTRUCTION CO.
Location 'dbe0,-F,0GEW00G DIVE Address 26 MONTROSE ST
Type Work WATER HARTFORD CT 06106
,he o. (860)953-8025
Date I nsp Needed s
Time Insp Needed a ^-v
Inspected By '
Work in Progress ArG
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Date (�
Per'mi '; 3462 Town of South Windsor, CT
Date 04/16/2003 Street Excavation Permit
Expiration Date 04/15/2004
Descrip: PERMANENT PATCH FOR MDC Pt�^
Applicant Location
Name M. J .D. CONSTRUCTION G D DRIVE
Addr. 26 MONTROSE ST
HARTFORD CT 06106 ATER -
Phone (860)953-8025
Applicant agrees t f or the amount of bond
required and to reim h ro-f r any expenses
incurred by the Town 94 ai connection with this
permit and that appli ar� a ide by the rules and
regulations for permit th Windsor's Street
Cut Permit Manual .
* * PERMIT TO ALL TIMES.
Issued SOR�"� -
by a a(
Date Completed Inspected By
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm `1 Phon No 6 a
Address of Fir C 0 L 46ff
Location of proposed work — _ o
Describe fully nature of permit requested L,-L
Starting date D L — 42 -2 — ® Approx.time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
` Amt. of Deposit$ 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: c L Date:
Title: !' C D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc