HomeMy WebLinkAboutWater Street Cut Permits Hillsdale Road 700200 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 11/28/07 al
GIS ID:43509999
MUNIS ry FEE: 25.0 APPLICATION# 200701928 v 0
.. ' �2ATION DATE:
r� 11/27/08
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APPLICA
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NAME ....
FOLSO M CON . ' ""
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a: 1gES `';` HLSDATE ROAD
ADDRESS: 138 RYES «,,.
STREET
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SOUTH WINDSOR " ; :;
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SOUTH WI
NDSOR
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». R CT 060742
PHONE � 734
860-528-892 8
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SCRIPTION:S C RIPT I ON:
W A T
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APP
LICANT
IC A NT AG
REES ��.r"ES TO FURNISH TH
E TOWN G T .TH 3 ° `.`. .." ' 0 .: B '
�'� � :.. .� ,�.,: Uhij�D,�REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY XF BTy :;ZNC p FOT 'Iv1 . TENANCE O
IN
CONNECTION WITH THIS PERMIT AND THE APPI TC1N 1`Ia, $ti1:> .;12„ (?lI 'plVj`$ LL`>BIDE BY THE RULES ANDPAIR EGU REGULATIONS
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FOR PERMITS AS OUTLINED IN THE TOWN OF S:"'O II W1�IpSRf STR IyT GII 'LR1VIIm MANUAL.
ISSUED BY DATE INSPECTED
INSPECTED BY
11/28/20079:08AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm
Address of Firm Phone No.
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Location of proposed work i/sd a/
Describe fully nature of permit requested c v�_ f, �,
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Starting date / Z p
Approx.time for completion �t0-
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South'Windsor
Pavement Cut
No.cuts
0 Est.Size of Perm.PatclXs)
Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit$
Total Due$ by
Cash )Check#
Permanent Patch
No. Cuts
Size of Patc tXs)
Final Billing
$
Amt.Due Payee
Amt.Due Town
By
Applicant is responsible for contacting
the Police De t.and C.B.Y.D. Dat
1 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 THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLI T N F SOUTH WINDSOR'S STREET CUT PE IT MANUAL.
Signed:
Date:_. I t Z �' 0 7
Title:_ �4
Driver's License M
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 7Cp,)0 CONTRACTOR: n
LOCATION:_ 4 ) I I S da f iDa ` -
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TYPE OF WORK: WQ4Q--- vyylo� t 1'�
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: D
WORK IN
PROGRESS: n-fK �� P,4tk
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AS-BUILT:
INPUT: DATE: _ �l
W/2007 Town of South Windsor INPSECTION REPORT 07