HomeMy WebLinkAboutDriveway Street Cut Permits 55 Elizabeth TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4045 Con.Ur'Actor JRJ �"'(OI SSTRUCTION & PAVING
Location 0055 ELIZABETH STREET A'cldre :; "'t<, 112IEj,GEHO"C4:..;ROAD
Type Work DRIVEWAY ;.;•::,1blE:ST• SfMS'R'-bRY''C:T, 06092
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Permit No. 4045 Town of South Windsor, CT
Date 07/21/2005 Street Excavation Permit
Expiration
p ration Date 07/21/2006.
Descrip:
Applicant"1 is ant
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Name JRJ CONSTRUCTION:::. x•. """`
&..PF 7i,`N. =>ruz: ^ C1AV,'i EET
Addr. 112 HEDGEHOG R6A6 r r
WEST SIMSBURY t1 06f9
of` Wor
Phone (860)658-57 5 0
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Applicant
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ts`` :; hzunt of bond
required and re 'm u
expenses
incurred by the Tows ',fiat ta'.a#7.kt' irer .,;., ' orrri'eeton with this
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permit and that appl"icant ,� aiw: �� Nr3.wx33bxde by.:the rules and
regulations for permits
P Uth..W'?&or's Street
Cut Permit Manual.
* * PERMIT TO''$F KE#�T: AI JOB,SIT ,,AT' LL' 7,TlES.
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Issued by --------
Date Completed --- Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT ydy-5-
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $2 .00
Name of Firm wf0. (`(�y '�7 Phone No.
Address of Firm
Location of proposed work
Describe fully nature of permit requested t< 0 C/ f
Starting date :
Approx. time for completion
Call Before You Dig No. r l raffic Services Control No.
Show sketch of proposed work or fumish
two copies of separate drawing Indicate North This section to be filled out by
71
Town of South Windsor
Pavement Cut
No.cuts
Est.Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
r Size of Patch(s)
Final Billing
Amt. Due Payee
Amt. Due Town
Al $
By
Applicant is responsible for contacting the Police Dept.and C.B.Y.D. Date
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 WI H THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS A OU NED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: 7�Z
Date:
Title: Driver's License#: M3
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES