HomeMy WebLinkAboutRepair sanitary lateral Street Cut Permi n TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4121 C
ont.x�:actor COVEN"Cf2NSTRUCTION CO.
Location 0041 GAIL LANE Address P O BO;X 427`...
Type Work RPR SAN LAT CQUENTRY CT
Phone'.No (86.1)282 `t7526
Date Insp Needed Date In
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Time Insp Needed
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Tamp Irp ;:
Inspected By
Work in Progress
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Input Date �_a�r`�_ =--
Permit No, 4121 Town of South Windsor, CT
Date 11/02/2005 Street Excavation Permit
Expiration Date 11/02/2006
Descrip: EXCAVATE TO REPAIR SANITARY. -LATERAL:
Applicant Loca'ton
Name COVEN CONSTRUCTION CO., f10;4i GAIL LANE:
Addr. P.O. BOX 427
COVENTRY CT 06238 Te of f}Or1C QR SAFT LAT
Phone (860)282-0526
Applicant agrees., to turnis!:h the 'own o;f South WindSbr tYe amount of bond
required and to reimburse the:: . 0 qt South NTsra sor f;o any exp ses
incurred by the TowltF. fo:r ma,10tenance or repair' `wor. connection with this
permit and that applicant 1 aml �S ^fi ' Wzt;7 zzd 'wsll abide ,by the rules and
regulations for permits as outline :the `bt4 Pb South W::;ndsdr's Street
Cut Permit Manual.
* * PERMIT TO BE <kEPT ON JOB 'SITE'A'I ALL;:;TIMES.
`' .
Issued by CJ , �✓, Titl e K' 'Gam ^'tl
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Date Completed ...—......
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Inspected By
HrrL1UA111UN FOR STREET EXCAVATION PERMIT 412,1
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm C/c, U
Address of Firm Phone No.
�A'
Location of proposed work_ (
Describe fully nature of per it requested
G
Starting date d
Approx. time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or fumish
two copies of separate drawing dicate North This section to be filled out by
Town of South Windsor
Pavement Cut
No.cuts
Est. Size of Perm. Patch(s)
Est. Pvt.Thickness 4— in.
Est. Unit Price 4W �
Amt.of Deposit$ Q-Z)C�,
�s
i i� ✓ Total Due$ by
c i ( )Cash(`)Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt. Due Payee
Amt. Due Town
By
Applicant is responsible for contacting
the Police Dept. and C.B.Y.D. Date
I AGREE T RNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT O BOND REQUIRED AND TO REIMBURSE THE
TOWN O U H WINDSOR FOR ANY EXPENSES_INCURRED BY THE TO N OR MAINTENANCE OR REPAIR WORK IN
CONNEC O WI H THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL BID BY THE RULES AND REGULATIONS FOR
PERMIT A UT INED IN T E TOWN OF SOUTH WINDSOR'S STREET CUT P RM MAN L.
Signed: Yl
Date: �J
Title: ��.
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES