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HomeMy WebLinkAboutDriveway Street Cut Permits 195 Governor TOWN Op SOUTH WINDSOR INSPECTION Location 3486 REPORT Permit No. 0195 GOVERNORS HIGHWp Cont Type Work DRIVEWAY raetor,gOLSOM CONS Addres TRUCTION LLC 138 „ 'YE STREET SOUTH 'WINDSOR"C1 06074 »phor�e'NC, (860)5a8: 892g;" Date Insp Needed _ Time Date I:rxsp Insp Needed --- ` Inspected By -----' `_— "Time Work in P rogress r 44 77 r� r ---_ Bate -3/08/2003 Town Descrip: PAR ate 05/07/2004 Street E South Windsor , CT KING LOT DRIVEWAY,.RE xcavation 5/1er ,.d Cg SRU S CTIpN Permit APPli,:ant a Name FOLSOM Addr. CONS TRUCTION,,LSC p. Lb :,. 138 RYE STREET taOn SOUTH WINDSOR OgVER�FORS` Phone (860)528- CT 00744 HIGHW}� 8928 Applicant Tie t�f W°rk DRIVEWAY to ree t© f required and rish ;the incurred reimburse Town Permit and that the To for maznteni. wn of': Sort h" uth W1nstS the.:: re9ulati aPPicant< anCe exr r 2ndsor fox. an meant of bond Cut Permits for anual,erm' is s�outlilliar, the panel i.21 gbx:. xp ns w.eith this M . enne ;tican hel at sun ' the -rulesand o S°ut * * PERMIT TO BE h Wlnds©r s Street Issued by sr ON Date ComPleted - Tlt1:e I,n,sp,e.t-t"eel By. t APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL IS40 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm Phone No. Address of Firm K • +z_(� �,., Location of proposed work Describe fully nature of permit reque Starting date l 2— Approx time for completion_ Call Before You Dig No. Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town of South Windsor two copies of separate drawing Pavement ut Indicate North Prop. size of cut No.cuts - Amt. of Deposit$ by ( )Cash O Check# Cut size after Perm. Patch No. Cuts Final Billing $ - Amt. Due Payee$ Amt. Due Town $ Applicant is responsible for contacting by the Police Dent. and C.B.Y.D. date 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. Signed: Date: Title: ��L°� D.L.#: PERMIT SHALL BE KEPT ON.IOBSITE AT ALL TIMES Standard Forms\Permits\Street Excavation Permit.doc