HomeMy WebLinkAboutWater Street Cut Permits 969 Foster Stre TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 2635 Contractor ENVIRONMENTAL SERVICES
Location 0969 FOSTER STREET Address MITCHELL ASSOCIATES
Type Work WATER 90 BROOKFIELD STREET
SOUTH WINDSOR CT 06074
Phone No (860)528-9500
Date Insp Needed Date Insp. "q
Time Insp Needed Time Insp.
Inspected By �: P .RNA
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Permit No. 2635 Town of South Windsor , CT
Date 03/16/1999 Street Excavation Permit
Expiration Date 03/15/2000
Descrip: HOOK UP WATER LINE TO HOUSE
Applicant Location
Name ENVIRONMENTAL SERVICES 0969- FOSTER STREET
Addr. MITCHELL ASSOCIATES
SOUTH WINDSOR CT 06074 Type of Work WATER
Phone (860)528-9500
Applicant agrees to furnish 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 applicant is familiar with and will abideby the rules and
regulations for permits as outlined in the Town of South Windsor' s Street
Cut Permit Manual .
* * (PERMIT TO BE KEPT ON JOB SITE AT ALLTIMES .
Issued by 5, it►'�A Title
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 $25.00
Name of Firm Phone_ No. i��.�d9 ��,2S u`0
Address of Firm �� ' _ ,
Location of proposed work -Crv� 0?
Describe fully nature of permit requested
Starting date / ( C/ Approx.time for completion —%�
Call Before You Dig No. —' Traffic Services Control No, 1
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
d
()Cash ()Check#
Cut size after Perm. Patch
t 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.
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' ' / �? Date: ®7�
P _
Title: - D.L.#•
PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc