HomeMy WebLinkAboutWater Street Cut Permits 50 Kelly Road 4
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 2889 Contractor STATE LINE SEWER & CONST CO
Location 0050 KELLY ROAD Address 238 SHAKER ROAD
Type Work WATER I 1 11ENFIELD CT 06082
Phone, ,No. (860 )749-61 76
Date I n s p Needed -- -� - --T ��t" I n s'p.Time Insp Needed " T1 e Irisp f=�
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Inspected By
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Work in Progress -410-
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Permit No. 2889 Town of South Windsor, CT
Date 11/10/1999 Street Excavation Permit
Expiration Date 11/09/2000
Descrip: WATER SERVICE CONNECTION
Applicant Location
Name STATE LINE SEWER & CONST C0 {3050 "`KELLY ROAD
Addr. 238 SHAKER ROAD
ENFIELD CT 06082 ?ypo of Work WATER
Phone (860)749-6176
Applicant agrees to furs sh th0 Town,-Of So
" uth, Windsor the amount of bond
required and to reiml(urse,"th"", 'own. of"".South *indoor for any expenses
incurred by the Town for Ymainirenance tar-, repatr work in connection with this
permit and that applicant is ;familiar wig"h and ill abide by the rules and
regulations for permitts as o Town; of South Windsor's Street
Cut Permit Manual . °
PERMIT TO 'BE . KEPT„ow"j, 6 :"SIT:E" AT. "AC"L TIMES.
Issued b - �
Date Completed -Inspected By
APPLICATION FOR
OF SOUTH EXCAVATION PERMIT
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm tcx— e— y Phone No. eJ 6 -7"—(p ( [ (o
Address of Firm_ le 't. •/1
Location of proposed work s h Vim-t r iL4
Describe fully nature of permit requested S
Starting date - TOL'� Approx.time for completion �- c� e�t��,5
Call before you dig no. 4(40 0( 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 $ 80. 16 by t dS�oo
Lam'
)Cash(heck#f /L 63�
f 5 'ter
Cut size after Perm. Patch
'�l ��• No.Cuts
Final Billing $
Amt, Due Payee $
Amt. Due Town $
Applicant is responsible for contacting
the Police Dept. and C.S.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO RFIMBURSE 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.N
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES