HomeMy WebLinkAboutWater Street Cut Permits 515 Graham Road TOWN OF SOUTH WINDSOR INSPECTION REPORT
,permit No. s. 3268 Contractor EASTERN WATERPROOFING
Location j Address P.O. BOX 504
Type Work RATE SOUTH WINDSOR CT 06074
PhoMe_ No. (860)875-6646
Date Insp Needed � Dae ;Insp..
Time Insp NeededTi Insp..
Inspected By
Work in Progress LCEE
IFC
Input C Date "(�
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Permjt No. 3268 Town of South Windsor, CT
Date 04/15/2002 Street Excavation Permit
Expiration 'Date -04/15/2003
Descrip: WATER SERVICE IN SHOULDER
Applicant Location
Name EASTERN WATERPROOFING "0615 s GRAlAM _ROAD
Addr. P.O. SOX 504
SOUTH WINDSOR CT 0807°4 �ry.�a 'of .Wo°rk WATER
Phone (860)875-6646
Applicant agrees to fernh t he Tcwrt .of SOUhr"'Windsor the amount of bond
required and to reimburse "the Town Wt, d. r for any expenses
incurred by the Town for me .rt enatvq� or ,-repair". rc rk. iri connection with this
permit and that applicant , .. wtth and will abide by the rules and
regulations for permi ts`�,as , q(j i i ned n ' heTowta '�of South Windsor' s Street
Cut Permit Manual .
* *,PERMIT TO 'BE KEPT ON',"' SITE AT ALL TIMES.
Issued by Title ^
e%aT �k
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 $25.00
Name of Firm �5 �c`p A- tw,, Ing CO Phone No. e,5�-3—7,,2-
Address of Fi •01 O l 5'J�,
Location of proposed work 575� :^�A 19"
Describe fully nature of permit requested w
Starting date l Approx.time for completion o
Call Before You Dig No. U D Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No. cuts 4�
Amt.of Deposit$ by
� �A
O Cash O Check#
Cut size after Perm. Patch
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.
Signed: Date: 1/510 -�
Title: D.L.#:
PERMIT SHALL BE KEPT ON)OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc