HomeMy WebLinkAboutMoled water connection using patch for w (2) 700218 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 12/20/07
GIS ID:43500028XP
MUNIS APPLICATION# 200702056 ` FEE: 25.00
~' `� :" EIRATION DATE: 12/19/08
APPLICANT,*;'
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NAME: BARBER UTILI -'f ">';y TIES LC � � ,_'ADDRE3S� -1.,.�ff<:�IIILSDALE ROAD
ADDRESS: P O BOX 331 J
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SOR CT 06074
PHONE - ;860 872-2330
WORK DESCRIPTION: MOL IS VGA>>>:
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'�` :. :����YTfi WATER MAIN
ANY P' i �`
A' ' 4 ATCH FOR MAIN
APPLICANT AGREES TO FURNISH THE I GOWN 'SI'I'II"lIjR I?I ()iJ41T{)FV"REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AA,ENSIN T0,4tQ MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE<.APPCAS:FT1I1 >ANI <; II :IBIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED Rj THE TOWN Ops6U`k"I W11 SIB s'Ah1£T'CU'I;P;P ANUAL.
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ISS ED BY ACE"INKED,.,. INSPECTED BY
12/20/200712:30PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: RD
WORK IN
PROGRESS: War C..414f W rri�+i 00 5
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AS-BUILT:
INPUT: DATE: ( ��
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm SIV60Z U L/ 7 C S Phone No. 7 2-2 3 3 v
Address of Firm L 0 6 o X l )Z') v
Location of proposed work_ 2 Q� /
Describe fully nature of permit requested nlF71,1 V/ rL
Starting date_ 12 - 2.61 -- () 7
Approx.time for completion_ / stet ,/7-14
Call Before You Dig No. 2 2 v Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Ind! to North This section to be filled out by
Town of South'Windsor
Pavement Cut
No.cuts
Est.Size of Perm.Patch(s)
E-j
Est Pvt.Thidmess in.
Est Unit Price$
Amt of Deposit$
Total Due$ by
( )Cash( )Check
#
Permanent Patch
i�
No. Cuts
Size of Patch(s)
Final Billing
Amt Due Payee
00
Amt Due Town
By
Applicant is reT2nsible for contactigg
the Police De t.and C.B.Y.D. Datp
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 TH THIS MIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS INED 1 E TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: .0 -v
Date: / 2- 2. 7
Title:
Driver's License#: 0 5^ 2 z. Z f3 S" 3
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
TOWN OF SOUTH WINDSOR
ENGINEERING DEPARTMENT '
ADDRESS
PERMIT NO. SHEET
UTILITIES OF
INSPECTOR TEMP.PATCH DATE
INSPECTOR COMPLETION DATE