HomeMy WebLinkAboutWater Street Cut Permits 124 Edgewood Dr TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3463 Contractor M. J . D. CONSTRUCTION CO.
Location G1241EDGEW00D LIR E'1 Address 26 MONTROSE ST
Type Work ' WATER HARTFORD CT 06106
OQ o. (860)953-8025
Date Insp Needed s o
Time Insp Needed
Inspected By ;.
Work in Progress o P
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Permit No. 3463 Town of South Windsor, CT
Date- 04/16/2003 Street Excavation Permit
Expiration Date 04/1-5/2004
Descr i p: PERMANENT PATCH FOR MDC RE�PS. �,,, ,
Applicant 0 Location
Name M.J . D. CONSTRUCTION G D DRIVE
Addr. 26 MONTROSE ST
HARTFORD CT 06106 ATER
Phone (860)953-8025 1.
Applicant agrees t 1 or the amount of bond
required and to reimb Me o h n�4 r any expenses
incurred by the Town _a Ien W pai connection with this
permit and that appli 9-nj ide by the rules and
regulations for permi n f S th Windsor's Street
Cut Permit Manual .
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* * PERMIT TO f LL TIMES.
Issued by (�NR `OR- �^VG
Date Completed Inspected By
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34-• 3
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm '�Ce e�-4 I Phc a No V- 3
Address of Firm - ,
Location of proposed workL/"
Describe fully nature of permit requested t
Starting date 0 /— 0.3 Approx.time for completion
Call Before You Dig No.:r)n o / `7 �T Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ 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.
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Signed: ga�/ - Date:
Title: f D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc