HomeMy WebLinkAboutDriveway Street Cut Permits 77 Foster St TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No 3379 Contractor CUSTOM PAVING
Location 7 Address JOHN F JURGELAS
Type Work titIVEWAY P.O. BOX 178
SOUTH WINDSOR CT 06074
h No. (860)528-2684
Date Insp Needed low L
Time Insp Needed
Inspected By
Work in Progress
mP"IY 91
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--r.l� Date
tarmit No. 3379 Town of South Windsor, CT
te 08/23/2002 Street Excavation Permit
Expiration Date 08/,23/'2003
Descrip:
Applicant " Location
Name CUSTOM PAVING ER STREET
Addr. JOHN F JURGELAS
SOUTH WINDSOR C o k DRIVEWAY
Phone (860)528-2684
Applicant agree ZD h ` W ndsor the amount of bond
required and to re u e ou d� for. any expenses
incurred by the To ► +f int re %ON in connection with this
permit and that ap i1i h "n abide by the rules and
regulations for pe u d South Windsor's Street
Cut Permit Manual .
* * PERMIT ALL TIMES.
Issued by CNJ /)�,', r
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Date Complet6d Inspected By
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• APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm L i,' 7_ i �` v ► G ey
Phone No. 7 ;7r — `
Address of Firm
Location of proposed work "7 7 r o JS
Describe fully nature of permit requested ew Z c , L )_
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Starting date 6 Z% _ Approx. time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish �{ To be filled out by Town of South Windsor
two copies of separate drawing 1
G Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ 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 by date
the Police Dept. and C.B.Y.D. \\ C1
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: % -M2 Date:__ / J
i
Title:__ D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc