HomeMy WebLinkAboutMiscellaneous Street Cut Permits 42 Jona TOWN OF SOUTH WINDSOR INSPECTION REPORT V
Permit No. 4287 _ Contxactor ANDRE CHARBONNEAU & SONS
Location 0042 Lathan bane ress 125"SDVFtN ROAD.
Type Work MISCELLAN 3flUT$, WINDSOR C:T 06074
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Date Insp Needed
Date Ill:9V
Time Insp Needed ` k
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Inspected Bye
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Permit No. 4287 Town of South Windsor, CT
Date 09/06/2006 Street Excavation Permit
Expiration Date 09/06/2007
Descrip: REPAIR CONCRETE SI;'ntWA'tK
Applicant Laca.tac?n
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Name ANDRE CHARBONNEPU & SONS 0 2 Jonathan Lane
Addr. 125 EDWIN ROAD
SOUTH WINDSOR, ! x. e 'p K»k M15CELUR
Phone
Applicant agrees to furYiisl ;'the Toafn of ox� h Windsor the amount of bond
required and to reibttrse, t »'
hE, Td'+xa q S uthfOr any expenses
incurred by the Town £qV k tdttaiance or refa r work an ' hnnectiQn with this
permit .
p and that apply cant `s,::fa'iri :: :: :::>• > .;:>,::r':>:::<: :":.>:::>:: ::il ?r. F > <>• .
�� �'��k ��i w3�7. �b�c�e by t1�e rules and
regulations for permits as tx �ned• the. u ,nf SouC:Ii SardSor s Street
Cut Permit Manual.
* * PERMIT TO SE XEPT OTC UYOB.•:u AT ALL TIME.
Issued by IPG
Date Completed
Inspected By 7
Hrr-LIGATION FOR STREET EXCAVATION PER
TOWN OF SOUTH WINDSOR MIT c'�,� W-✓
PUBLIC WORKS DEPARTMENT
TOWN HALL Per
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
Name of Firm ��r� FEE $25.00
Address of Firm
� �
Location of proposed work t Phone No.v. ��k�
d�ha �`1 Grp
.Describe fully nature of permit requested rP-tMa�
au
Starting date
Call Before You Dig No. Approx. time for completion 1^1'
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing
Indicate North This section to be filled out b
Town of South Windsor
Pavement Cut
No.cuts
Est.Size of Perm.Patch(s)
Est.Pvt.Thickness
Est.Unit Price$
Amt.of Deposit$
Total Due$
by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of patch(s)
Final Billing
Amt.Due Payee
Amt.Due Town
Applicant is res onsible for contactin BY
lice De f
the Po .and C.B.Y,p
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AM
TOWN OF SOUTH WINDSOR FOR ANY
CONNECTION WITH THIS PERMIT AND THAT I AM FAMILIAR WITH EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REP
AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
PERMITS I OUTLINED IN TH TH AND WILL ABIDE BY THE RULES AND
Signed: OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. AIR WORK IN
(� REGULATIONS FOR
itle: Date: tp
Driver's License#:
ERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES