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HomeMy WebLinkAboutRoad Cut Street Cut Permits 140 Foster R `4Urt '. ...,,4 BOND TOWN OF SOUTH WINDSOR Am't Req. PUBLIC WORKS DEPARTMENT Date TOWN HALL Am't on File 1540 SULLIVAN AVENUE Permit No. SOUTH WINDSOR, CT 06074 to of Expiration Permit Expires APPLICATION FOR PERMIT FEE $10.00 _T Name and address of applicant .-, C Phone No Location of proposed work � ,, (;iA � — 1��t:: ��=� � i�!c Describe fully nature of permit requested .: .,Lk �.: Insurance on file with Town es no . Date policy expires rl i Name of Insurer 4"-,c U I E o Approximate time for completion Desired starting date �d U Show sketch of proposed work or furnish 2 copies of separate drawings a �a w 0 0 04 a� 04 o U O cad U ,,4 —4 04 Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG. 04 lqi I agree to furnish to the Town of South Windsor the amount of bond or deposit 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 (Pavement Cut Regulations.) Signed ✓ APPROVED: DATE APPROVED: / '� ~ DATE b-_ Supt, of Highways `2Z,,P Town Engineer r FOR INSPECTOR:. Date work started Date completed Sufficient notification received: yes no. Type of repair: Perm. Temp. Unusual conditions encountered Material slips attached: yes no Dated for Permanent repair Signed Inspector AI/III�I�. � ■■ ■ " � , R l ISSUE DATE(MM/DD/YY)p k 6/22/88 PRODUCER Buckley Ins. Of Ct. Inc. THIS CERTIFICATE IS ISSUED A INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, PO BOA 579 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Tdsor Locks, Ct. 06096 COMPANIES AFFORDING COVERAGE COMPANY CODE SUB-CODE LETTER A Aetna C & S 1125 COMPANY INSURED LETTER B Art Barber Excavating, Inc. COMPANY PO Box 428 LETTER r+ Ellington, Ct. 06029 COMPANY LETTER D COM A P NY LETTER E COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATION j TYPE OF INSURANCE POLICY NUMBER ALL LIMITS IN THOUSANDS LTR DATE'(MM/DD/YY) i DATE(MM/DD/YY) i . GENERAL LIABILITY GENERAL AGGREGATE $ ► V V A x COMMERCIAL GENERAL LIABILITY ' Renewal of ' 7/l/88 7/l/89 PRODUCTS-COMP/OPS AGGREGATE g$ L,000 CLAIMS MADE x OCCUR.1 07CO140844CCA 1 1 PERSONAL&ADVERTISING INJURY $ �aQ© OWNER'S&CONTRACTOR'S PROT.` EACH OCCURRENCE $ 11,000 x Underground FIRE DAMAGE(Any one fire) $ 59 MEDICAL EXPENSE(Any one person) '.$ AUTOMOBILE LIABILITY COMBINED j SINGLE 1 ANY AUTO Renewal of 7/1/88 7/1/8A _i LIMIT $ ALL OWNED AUTOS 07FJ7319 84CCF! BODILY INJURY :$ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ x NON-OWNED AUTOS (Per accident)I GARAGE LIABILITY :PROPERTY $ ;DAMAGE ._ EXCESS LIABILITY EACH AGGREGATE OCCURRENCES A x Renewal of 7/1/88 . 7/l/88 z $ 1,000 1,000 OTHER THAN UMBRELLA FORM 07XS527790NCA F STATUTORY WORKER'S COMPENSATION A AND Renewal of 7/1/88 ? 7/1/89 $ 100 (EACH ACCIDENT) 07CB53094CPI $ 500 (DISEASE—POLICY LIMIT) EMPLOYERS'LIABILITY O T). $ 100 (DISEASE—EACH EMPLOYEE) OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS Various CERTIFICATE IioLbkh IrdN&LLAtIdN Town of South Windsor SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town Hall EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO �40 Sullivan Ave. MAIL-3.Il_DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Windsor, Ct. 06074 'A LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR R ESENTATIVES. AUTHORIZED REPRESENTA E ACORD 25-S,(3/88) ,;; .. 7. (r is A � � > PMPERTY OF BRIAN & TRACY MARTIN . POSTER ROAD SOUTH N I N DSaR OONNECTI(Alr •+ SCALE 1" a 401 A10AIL 1988 Being Parcel 2 on a map entitled "Property of James H. Jack- -'son Et All'. Dated August 1987 BF_1W&1'`�,4,ex- NAi/ Z,41f S' H TAfi!'SON /N S VEr E & zgi?- Zr 44L t1 /DO Q� ASSU�yEO q� 16 / 94 es-, E 04�► i E �► 150, 475- SF. �` i �kew � b D 7 7,S' ' w .S 3 /9' —Q0" W " • V/�VT- 6;ff /0VF_5 7tn'o 4'`-'04 W,Gy4rA-AV /a2.0 :T //YC //DG(SEGO✓FPS 3. 7 % Ox .COT "VISCJ JULY 9 /.988 Ae�vis co S:Ar tI i98B Building to be constructed - House hereby NTt 1 t V rilat this map r GoNV Building rcmpleted as shown s substan ialiv correct And ° oFCT or, asap and survey is hereby °•hat the zoninu or-Iinances of +%` 4�i=O� te_certified as norrect and * tn'Am of iout'h 4indaor0 o ' t zoning regulations not vio- ►r.,. have n»t been violated, • lated, # 1�.7lAi c� �'ct N et40 / 10 8 U R q Ey A PR.OVERTY OF BR I A N IC T R A C Y MARTIN POSTER ROAD . SOUTH WINDSCR OONMCTICUT SCALE 1" = 409 APRIL 1988 Being Parcel �2 on .a map entitled "Property of James H. Jack- `son Et Al". Dated August 1987, MOO J"A/fES H TgGE"SON /N SNEr �t,F' ,# Z4iz ET AL f1 /00 Q� ASSUiYEO S q� qb q4 �0 Q� n r P. SOS� , f .53 /9 —Coll W Hod ,/ /Y S3 ..•/9 /°`I'eST =Z- O t /Oz • V/NT.4GE ,S(�3yES T1�Lo 4"--,0 PW&C,4Tie.W /02.0 //YC• GAPAGL� fLLC 9yt,� . TA Q HDl.[sE��✓E,PS 3. 7 % Of 107- /�' LOT NOr/�y F HAZ9rP0 IG'1vE' "ViSCa JULY 9 /.98V + fib, „ q�ti i Building to be consrructed - House *hereby - -,rt i t v -�iat this map 0co NH Building ctmpleted as shown e substan ial 1 v c �,rrecr And Fe `hat the zoninu ordinances of ;�+�`�N�����'C� or, step eztei survey is hereby c ee-certified as norrect and * town of 'iouth vJin�iaor, � � " t-win. have n r%t be rn v 1.01 a t td, zoning regulations not vio-*AL Lated • MI `�ti SCE N il��QQ � BURVE