HomeMy WebLinkAboutDriveway Street Cut Permits 27 Hollis Ro TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No.
Location `' ���__`� �
Cont.r:actor BOUTIN &,,,SONS
1Address
Type Work DRIVEWAY 121 W:INDSOR'VI...
LLE ROAD
k�RQAD "OO' CT 9:.6016
Phor�e`.No ($ E�)623=2526 :,
Date Insp Needed ---------- bate T
Time Insp Needed
Inspected By 'J
Work in Progress
---------- I np u t �—
Permit No. 3769 Town of South Windsor, CT
Date 06/17/2004 Street Excavation Permit
Expiration Date 06/17/2005
Descrip:
Applicant Location
Name BOUTIN & SONS 60 '7 HOLLIS ROAD 'a
Addr. 121 WINDSORVILL� RpAD:': is
BROAD BROOK CT U6,Q16 �e 'n,f ti4brk DRIVEWAY
Phone (860)623-2526
Applicant agrees C'o furnish::: the T. . of .. Windsor the aiiio'int of bond
XXX
required and to reinkytirSe 'kkle Town ct€ St�uthG323rso,r,fear any :expenses
incurred by the Town for** ia;isteziance"'or` repair w�rin c'onnectipn with this
permit and that applloant :s �a1� '1�sr �a th as c�'wi17; abzde by the rules and
regulations for permits as outlined fizz the Towh of SqutIi.W.��dsor's Street
Cut Permit Manual.
* * PERMIT TO '$E KEPT ON iOB "TT AT.AFui TIMES.
Issued by _; Title ._
Date Completed Inspected y _ _J
Y APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC' TOWN DEPARTMENT
1-7 1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
a
Boutin & Sons Const. Co. 623-2526
Name of Firm Phone No.
Address of Firm 121 Windsorville Road BroadBrook, Conn 06016
Location of proposed work 27 Hollis Road
Describe fully nature of permit requested Strip Pxi cti ng ri NzeWny, pljt ,�rocess_gr=Qi
grade, roll and pave
Starting date Approx.time for completion
Call before you dig no. ZUU424030 Traffic Services Control No.
Show sketch of proposed work or fumish To be filled out by Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No.Cuts
Final Billing$
Amt.Due Payee $
Amt.Due Town $
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 WJNDSOR 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.
6/14/04
Signed: Date
Title: D.L.#
xr
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
OFF PLEASANT VALLby Ku" bL 1 c v
Job Location:
' Description: u
6/4 �
f o (A
l fi
7w
Quote Good for 60 Days. on Completion.
Balanc
Special Attention: 1/2 Payment Upon Starting, permit
Contract I
Ld
ON WORKM NSHIP &MATERIALS.
�4z
ONE YEAR GUARANTEE
Date
CBUD
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