HomeMy WebLinkAboutDriveway Street Cut Permits 117 Hillside TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3259 Contractor BOUTIN & SONS
Location Type Work DRIVE Address 121 WINDSORVILLE ROAD
WAY '
BROAD BROOK CT 06016
Phone No. (860)623-2526
Date I nsp Needed
Time Insp Needed
r Insp.
Inspected By
Work in Progress
Input �(��� Date
PerR 611141�. 3259
Town of South Windsor, CT
D .te 03/28/2002 Street Excavation Permit
.Expiration Date 03/28/2003
Descrip:
Applicant Location
Name BOUTIN & SONS �a11ZHTLL:SIDE DRIVE
Addr. 121 WINDSORVILLE ROM)r'
BROAD BROOK CT 060 6 . Type of Wor* `DRIVEWAY
' Phone (.860)623-2526
Applicant agrees to furrzYst the` Town of 'at)` ; Windsor the amount of bond
required and to reimburse, the Tow.h oi= Sauth Wihdgor, for any expenses
incurred by the Town for IYTAintenance or ;t',zpair .wor"k in connection with this
permit and that applicant is fa iSa ar WIth- and, wfl1 :abide by the rules and
regulations for permits ,as outlined in the 'Town of South Windsor 's Street
Cut Permit Manual .
* * PERMIT TO .BE KEPT ONv jOB .SITE AT ALL TIMES.
Issued by Title
Date Completed __ = OoZ Inspected B
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 l` Phone No. ~
Address of Firm
Location of propose work
Describe fully nature of permit requested
Starting date Approx.time for completion
Call before you dig no. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt. of Deposit S by
Cash O Check#
y
Cut size after Perm. Patch
No. Cuts
Final Billing S
Amt. Due Payee S
Amt. Due Town S
Applicant is responsible for contacting
the Police Dept. and C.B.Y.D. by 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: A Date:
Title: ( � j�,� D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES