HomeMy WebLinkAboutDriveway Street Cut Permits 261 Hilton D TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 3582
Location 0261 HILTON DRIVE contractor CUST6k: ;d�VING
ss; OH :URGELAS
Type Work DRIVEWAY Addre J N FJ
B6x ,178
OiITH WIDIDSO�t CT 0:.6074
Qkione No". {g6'pl S28 ;2684
Date Insp Needed
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Time Insp Neededme qspj:
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Inspected By
Work in Progress-----------------
77
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Input Date `—
Permit No. 3582 Town of South Windsor, CT
Date 09/04/2003 Street Excavation Permit
Expiration Date 09/03/2004
Descrip:
Applicant I,aca'tlbn
Name CUSTOM PAVING 616!j NILTON,DRIVE'";
Addr. JOHN F JURGELAS
SOUTH WINDS OR CT .0074 Te Q .:Wbrk ,pAI�JfijY
Phone (860)528-2684
Applicant agrees to fUrnash the Town'.. South Windsar ,te amqunt of bond
required and to reiburse tFa.� Towstaf. .Sou
m 2'14t Wzaseaz.. flr:'any expenses
incurred by the Town €dt fqd t4nanCe or repair'wor in coiineqtion with this
permit and that applicant 3s`f8tt1il' a u*ah axti,`wil b�cte;by the rules and
regulations for permits as crjitline.tl z�'tta So rn of S.quth, -j..ndsor's Street
xxxx
Cut Permit Manual.
* * PERMIT �TOjI BE<:RRPT„ON'Js7BiSITL+"'11T AIL:;.TTME'S.
Issued by
Date Completed _ ------ Inspected By ;
1
• APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm V ' n ram-• ti I Phone No.
Address of Firm
Location of proposed work
Describe fully nature of permit requested r
Starting date Approx.time for completion G'
Call Before You Dig No. Traffic Services Control No.
, 2
Show sketch of proposed work or furnish 7I two copies of separate drawing To be filled out by Town of South Windsor
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt.of Deposit$ by
i
( )Cash ( )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 WJNDSOR THE AMOUNT OF BOND REnUJRED 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:
Title: D.L.#: C )
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc