HomeMy WebLinkAboutDriveway Street Cut Permits 335 Graham R Permit No. TOWN OF SOUTH WINDSOR INSPECTION REPORT
3807
Location 0r
0335 GRAHAM ROAD .
Co��:g•ctory4UALI,Tt"?AVING CO.
Type Work DRIVEWAY
3° 194 @tiS AINL:.STREET
06088
Date In `
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Time InsP Needed 'r:'•..
Inspected
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Work in Progress
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Permit No. 3807
Date 07/28/2004 Town of South Windsor, CT
»>: Street Excavation Permit
Expiration Date 07/28/2005
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QUALITY
PAVING CpName • ..`.«x"'
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Addr. 194 S. MAIN STR9aET.
EAST WIND
SOR CYAll Ai! ;r
Phone (860)523-4182
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Applicant a reedo.,.:
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re < �> :?,,. •<ay i` Wind gr9 sCl e r`amo4nt of bond required and to rei`tnb%.3;* :t � , nd
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incurred by the Towz. for. dxpeses
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permit and that appl''�G <. ' ' nct`imn with this
ulatiy '. rao- 3, „rs !' ,k., « "ac�'e''by<::tive rules and
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9 ons for permits as 'butii' `' A :
Cut Permit Manual. h: r Sott1� Ylindaor's Street
PERMIT T6%.,Bi kidt�BT""�1.,:J�B::r
Issued by
Date Completed __----_--__— Inspected By —
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit o.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm Phone No.
Address of Firm ` /—.
Location of proposed work
Describe ully nature of per it requ sted
Startin to .�
- «� Approx. time for completion
Call Before You Dig Traffic Services Control No.
Show sketch of proposed work or famish
two copies of separate drawing Indicate North This section to be filled out by
Town of South Windsor
Pavement Cut
/ No.cuts
Est.Size of Perm.Patch(s)
Est.Pvt.Thickness in.
IJ
Est.Unit Price$
J i Amt.of Deposit$
Total Due$
/ by
)Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
i
-- - -
.ir_- -- - - Final Billing
e $
Amt.Due Payee
�4 $
Amt.Due Town
By
Applicant is responsible for contacting the Police Dept.and C.B.Y.D. 26jc 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: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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BOND TOWN OF SOUTH WINDSOR a
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
W 't on 'File 1540 SULLIVAN AVENUE Permit No.
. SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE $10.00 .L�y?''✓lam
Name and address of applicant Ph
s �.
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�J+ one No.
Location of proposed work
Describe fully nature of permit requested ;, >;
Insurance on file with.-Town ,,yes now_ Date policy expires_� j,y;
Name of Insurer ,�lr".v � �, >
o Approximate time for completion Desired starting date
cd
Show sketch of proposed work or furnish 2 copies of separate drawings
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0' Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
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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 rbpair
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: f DATE
Supt. of Highways �'-"�' ? Town Engineer
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