HomeMy WebLinkAboutMiscellaneous Street Cut Permits 209 Fel TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4107 Cont.-a'ctor ,•COSTA &""54N, LLC
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Location 02 .PEZ4 ROAD AddreS P.O. 'SOX'<658
Type Work MISCELLAN :S UTH WINDSOR CT>.06074
Phone No: (8fipj•:544 249
Date Insp Needed
-------------- Date Trs sip
77
Time Insp Needed Time In
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Inspected By ��
Work in Progress CO"J s
Permit No. 4107 Town of South Windsor, CT
Date 10/14/2005 "" Street Excavation Permit
Expiration Date 10/14/2006
Descrip: REPAIR CONCRETE SibiWAT
Applicant ;Loc .tOa
Name COSTA & SON, LLC dp9 FELT ROAD
Addr. P.O'. BOX 658
SOUTH WINDSOR CT 66074 y e,of v +r1� MISCEL7..
Phone (860)644-2499
Applicant agrees; to �lrn�s the Iqw SAt3t Win
dorr tkie ,arrYornt of bond
required and to reiii}btir e:tlae o xi £Srautk� W tdstiar for: and �xpelzses
incurred y the Town:. ka;Y rty u:t: nanCe""fire'T 'p"eir"`'�f 'rk,; zi �:jlnectidn with this
permit and that appll can
E is faq�il'3a�:trhuii 'u11bid
ley �Y-e rules and
regulations for permits as:.., out:Jins`d ' ti ," 1 ' tF ,:p'f""Sou .i W. n.ds r's St
reet
Cut Permit Manual.
* * PERMIT TO'`BE K$ ON SOB S�;�E 1�7 AI I, TIMES.
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Issued by
Date Completed -- kj �� Inspected By —
APPLICATION FOR STREET EXCAVATION PERMIT * t
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm Phone No.
Address of Firm ��-
Location of proposed work ' � TqLL,-v V Ao
Describe fully nature of permit requested �g?AIE- C-,,Ax- Sip�.waLr,
Starting date G'c-T, "?t4-;Zav Approx. time for completion Oct 2.a -Zrr,-s
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or famish Indicate North This section to be filled out by
two copies of separate drawing Town of South Windsor
Pavement Cut
No.cuts
0 Est.Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt. Due Payee
Amt. Due Town
BY
Applicant is responsible for contacting 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 INDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES