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HomeMy WebLinkAboutDriveway Street Cut Permits 10 Kupchunos X " TOWN OF SOUTH WINDSOR INSPECTION REPORT x Permit No. contractor BOUT' Location Location 0010 Address 121 ':WINDSORVILLE ROAD Type Work DRIVEWAY BRQAD BPO€Uk CT <:0.6016 Phone No (Sfa©J 6:2s 2:5,26 Date Insp Needed Time Insp Needed p; ' Inspected By it T # Work in Progress Input ( — Date _NAT i ` Permit No. 3714 Town of South Windsor, CT Date 05/21/2004 Street Excavation Permit v Expiration Date 05/21/2005 Descrip: Applicant Locand on Name BOUTIN & SONS Q01Q WXND HILL D JVE IT Addr. 121 WINDSORVILLE' ROAD BROAD BROOK CT 06016 i, 'pe d? ..:WoX DRIVEWAY Phone (860)623-2526 Applicant agrees to:: furnish Ghe �wn,o South Winr,sQT,.the aYnaunt of bond required and to reimburse the, 'own of Sp .th Candsor for any .expenses incurred by the Town ft x masn enact e err r p it syork i3z tonne tiOn with this permit and that applicant is 'E milzar with and .ai l:&bid b� the rules and regulations for permits:?as outixneda>an the Zpr .ao Si�th'WndsOr's Street Cut Permit Manual. * * PERMIT 'TO BE KEpT Q1V Z{�B''SIT�. AT 7dLT ,;.TIMES :'* Issued by Title Date Completed By ��� APPLICATION FOR STREET EXCAVATION PERMIT 3 TOWN OF SOUTH WINDSOR PUBLIC, WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm Boutin & Sons Cons t. Co P one 623-2526 Address of Firm S O , �O Location of proposed work y Describe fully nature of permit requested strip existing r i v ewa y, add grave , grace, roll and pave Starting date Approx.time for completion Call before you dig no. 20042101812 Traffic Services Control No. Show sketch of proposed work or furnish To be tilled out by Town of So Windsor two copies of separate drawing Pavement Cut Indicate North Prop.size of cut No.cuts Amt.of Deposit$ by O Cash O Check# Cut size after Perm. Patch No.Cuts Final Billing S Amt. Due Payee $ 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 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. Signed: 5� ��sc� Date• 5/19/0 4 Title: -T� D.L.# PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Job Location. � 4q Description: It `Wp d � Z 1 Quote Good for 60 Days. special Attention: 1/2 Payment Upon Starting, Balance Upon Completion. ;4 p Permit Contract ONE YEAR GUARANTEE ON WO MANSHIP &MATE IALS. Date CBUD ,r