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HomeMy WebLinkAboutDriveway Street Cut Permits 53 Old Paris TOWN OF SOUTH WINDSOR INSPECTION REPORT r Permit No. 3657 Location 0053 OLD PARISH DRIVE Cont> r BOUTIN:& SONS Type Work DRIVEWAY Address 121 WINDSOR'VSLLE ROAD BROAD 8R00k :CT Q6016 Phone; 623 2526'z; Date Insp Needed -------------- Time Ins p Needed Inspected By io Work in Progress InputDate --� Permit No. 3657 Town of South Windsor, CT Date 04/01/2004 Street Excavation Permit s Expiration Date 04/01/2005 Descrip: Applicant Location Name BOUTIN & SONS ©p OLD,; TA�tISIi pRIVE ':. Addr. 121 WINDSORVILLE' ROAD BROAD BROOK CT 060,36 hype d Wotk.D;RIV8WAY Phone (860)623-2526 Applicant agrees to+: urnzsh the 'own of Sough Windsb 'the amount of bond required and to resmbu �se th.:,Town of uatith Wari.dsor f:prr}y expenses incurred by the Town far maxn[ena# e�aAx woxk t'n tofzneG iin with this permit and that appj1'Qa 1t 1s :famili'ar wl� and r211 ab'de' b;X tb;e rules and regulations for perms t:g 'as outlined::i. the wn'' c5 Stti zth Windsor's Street Cut Permit Manual. * * PERMIT O BE,::1'E .OTT dd SITE,;AT Z1T L itle Issued by -----�— a T Date Completed =�0 ---- — I>n>sp'61cted B APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR I PUBLIC- WORKS DEPARTMENT 3 � S 7 TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 m Name of Firm r 5 1 Phone No. 3-asa(0 Address of Firm r Location of proposed work Describe fully nature of permit requested Starting date 'All Approx.time for completion Call before you dig no. Traffic Services Control No. Show sk ch of proposed work or furnish To be filled out by Town of So Windsor two copi s of separate rawing Pavement Cut In cate North Prop.size of cut No.cuts Amt.of Deposit S by ()Cash()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. t � Signed: Date: Rd9 Title: D.L.# PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES \o�