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HomeMy WebLinkAboutWater Street Cut Permits 22 Gray Road TOWN OF SOUTH WINDSOR INSPECTION REPORT Permit No. 3442 Contractor CONNECTICUT WATER COMPANY Location -Q02,2 (V, Address 25 NORTH ROAD Type Work WATER EAST WINDSOR CT 06088 e No. (860)292-5552 D ate Insp Needed T i me I nsp Needed Inspected By f Work in Progress ' hued o� t 1 lJ `!1 P' SO Ra ��/►��' Date Q' , Permit, " 3442 Town of South Windsor, CT Date 03/10/2003 Street Excavation Permit Expiration Date 03/09/2004 Degbrip: WATER MAIN BREAK 0 GRAY & BREWSTER RD. (8'X 15 ' )CUT Applicant Location Name CONNECTICUT WATER CO ANY� G4AY OAD Addr. 25 NORTH ROAD EAST WINDSOR CT 06 WATER Phone (860)292-5552 Applicant agrees t h or the amount of bond required and to reimb fte o th 0 r any expenses incurred by the Town et k4 connection with this permit and that appii an ide by the rules and regulations for permi s 1 th Windsor's Street Cut Permit Manual . x Q * * PERMIT T � + L TIMES. Issued by Date Completed Inspected By r ' ^ ** (.��LL �EFORE YDU D�G — C�) Q3/�3/2Q03 �7s15: 57 ***** EME9GEkCY *+*** ��� �� ~~ , ` TYPE 3F �GRi\' ' . . . EXC [� REPA1R �� R �!A�� GP�OK RE�3�KS� �OPK� �5 �f THE ST �T THE IN�E9. . . . . EhA�i A�0R�6S' . �L]6ON CON��CTL�)' P�R�/}N CON �A��TED: APPLICATION FOR STREET EXCAVATION PERMIT 'OWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL .5 0 SULLIVAN AVENUE. SOUTH WINDSORr CT FEE $►25.00 Firm _ r ✓�✓��c i� 1,� � - �'- Name of 2 � � � �� Phone No._ r�"/? �L��_�.� � � �....5 5�� Address of Firm 2 /L//.) 7 A Ci /=t Tt�,-; �, ✓.�v,— ` Location of proposed work 2 Z 6-1-�; I? Descrlbe fully nature of permit requestedx :' y, >7_ ✓�. Tc� y zr ;- �{ G✓ri 1 � ✓i';�ro`t� !✓o✓,v ) © : s Starting date_--I:::Z-03 Approx. time for completion ✓ Call Before You Dig No. �E nV d 0000.31 'traffic Services Control No. Show sketch of,proposed work or furnish To be filled out by Town of South Windsor two copies of separate drawing PavCment Cut . Indicate North Prop. size of cut No.cuts Amt. of Deposit$ by Cash () Check# ii , j Cut size after Perm. Patch No. Cuts Final Billing $ Ion 2?. 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: 5-0_3 Title: JF?i :o`' ,� r-�i C r� ✓�� '. D.L.# PERMIT SMALL BE KEPT ON 30BSITE AT ALL TIMES Standard Forms\Permits\Street Excavadon Permit.doc