HomeMy WebLinkAboutDriveway Street Cut Permits 236 Fairview y TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3870 Con trc:ta BC?UTI'N«,,& SONS
Location �36" PAP4Z I g yE Addre.$ 121 IN,.P,SO`I:M.ILLE ROAD
Type Work DRIVEWAY
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Permit No. 3870 Town of South Windsor, CT
Date 10/08/2004 Street Excavation Permit
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Expiration Date 10/08/2005
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Descrip•
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Applicant
Name BOUTIN & SONS FAIRVIE,:>`D�?I' .E``
Addr. 121 WIN DS ORVI LL
BROAD BROOK CT
0 6:411 6:�:'
Phone 860 62 -� ) 3 2526 ,
A licant a reet`"
PP g o..ftiz11,.. e;.::a.mo int of bond
required "''"
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red and to re "�nksur'
incurred by the TowY .rFr r[12# nan'ce;o'r>`;r :a: r
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permit and that a 1` "' "•z<:.=-
PP �.cari `is=: aT[tix ??<st:' « E
:)jyttie rules and
regulations for permits as.. Vd ts� 'd:':�ti'the,': S4�t"th f�l::.', "x axids or s Street
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Cut Permit >-Manual.
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* * PERMIT TO'"''BE•ICP
Issued by
Date Completed -- Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Boutin & Sons Const. Co. 623-2526
Name of Firm Phone No.
Address of Firm 121 Windsorvi e Ro—aEF Broadrook, Conn 06016
Location of proposed work 236 Fairview Drive
Des ribefullynatureofpermitrequested trip existing riveway, dress wl process
Unravel, grade, roll and pave
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. Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit S by
(1 Cash()Check#
Cut size after Perm. Patch
No.Cuts
Final Billing $
Amt. Due Payee S
Amt.Due Town S
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 ASIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title: D.L.# ;
PERMIT SHALL BE KEPT ON JOBSITE AT ALLJIMES
Job Location:
Description: 2
0
Quote Good for-4Days.
Special Attention: 1/2 Payment Upon Starting,-Balance Upon Completion.
Contract \ Permit
ONE YEAR GUARANTEE ON 507KMANSH r& MATERIALS.
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CBUDV Date
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