HomeMy WebLinkAboutDriveway Street Cut Permits 224 Fairview TOWN OF Permit No. SOUTH WINDSOR INSPECTION REPORT
Location $
�$ ffi' Bt CcnxaEtor
Type Work DRIVEWAY BOUTI <&.:.
tfcir �,.> SONS
. X'.ORVrT.LLE ROAD
P?torir+ ;Iqf; ,,rx«:] iD,.B�'Oa ' C.,T"''p.601
Date Insp Needed
Tim —� � • Date i � �
e Insp Needed —__—_ 4 ;<,. 3 • —
"
Inspected „5+ :+Wortti
ff
g ,
k in Progress
'%Qi
Date 3873
10/14/2004
TOW' of South Windsor, CT
Expiration Date a: Street Excavation
Descrip; 10/14/2005 ation Pe rmi t
Applicant
Name
Addr, BOUTIN & SONSLY?oation
12.1
INDSORVILL
BROAD ROAb mx� y �2 � 23 .EG7
Phone BROOK CT b6Q6 s ti�� a uE
(860)623-2526 r Ws
Applicant a ° D'i2 &AY
re grees ..t'ry fu
required and to reEh thew`> a
incurred b zmirse7�e flown f� 9uh Winlse3 `
Permit y the Toyin <gtlr #} j ° yt � 4dsor for E?�etnciunt of bond
and that aPP i.fi C e2 �y ^ n expenses
regulations for per mia� �xkf{ ne3rn
wir P�tirjn
Cut Permit Manual
asucsg a a h with this
ar) 34` t1e
y A,�" ? oot ?indsbr sules Streetd
* PERMIT` O B
T pW n$
ssued by �, AT ALL TT
Date C it
Completed —
------—
ed By �
Y APPLICATION FOR STREET EXCAVATION PERMIT
- TOWN OF SOUTH WINDSOR '�
PUBLIC- WORDS DEPARTMENT ?�
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm
Boutin & Sons Const Co 623-2526
� ,[V,p
Address of Firm121 in SOrvl e Roanroa roo , n Ph oU�Ul�
Location of proposed work 2241 Pairview rive
Describe fully nature of permit requ sted Strip
i put n gravel, grace, roll n
Starting date Approx.time for completion
Call before you dig no. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So WindSOC
two copies of separate drawing Pavement Cut
Indicate North
Prop.size of cut
No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No.Cuts
Final Billing $
Amt. Due Payee $
Amt. Due Town $
Applicant is-responsible for contacting
the Police Dept. and C.B.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF
SOUTH WJNDSOR 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.
fl,�Signed: zL Date: / d
Title: !o D.L.#
rs .
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Description:
P ass
191
2�
So
Quote Good fort' Days.
Special Attention: 1/2 Payment Upon Starting, Balance Upon Compi ion.
Permit
Contract
::K::_
ONE YEAR GUARANTEE ON WORK
CBUD Q HIP & MATERIA
LS.66M
Date
f
s
a�