HomeMy WebLinkAboutDriveway Street Cut Permits 142 Palmer D Permit No. TOWN OF SOUTH WINDSOR INSPECTION REPORT
3995
Location g' ' R DRIVE Cont,ravt6y"'—
TYPe Work DRIVEWAY ar $S w; 121'c<:yV2 ' SONS
LTASOPVILLE ROAD
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Permit No. 3995 Town of South Windsor, CT
Date 05/27/2005 Street Excavation Permit
Expiration Date 05/27/2006 W za f
Descrip:
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Name BOUTIN & SONS �y'Q2 PALMER''` U- x"
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I Addr. 121 WINDSORV L
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BROAD BROOK CT:'.< 0:£fll" >�
Phone 860 — ^! .''•'•:;"�c•
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Applicant agreeota: IV, zk, f� r h wiri scp ,Chi,^ombunt of bond
required and to rekiurs T`C3ujj otT .. .; '^ '"'an �c "enses
incurred by the ToWn., e3•r n" nance oY fepair w'orde V;i 3 .onp ction with this
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permit an " y..
p d that app^ irit":: < €fi y' es and
'. .., q..'b 'he rules
regulations , s'''puii :..:r r
for perm is >s n;' li .. of 9ti'th'<ai' r3sor s Street
Cut Permit Manual. ;q ::• ': a'''i; .
* * PERMIT TCJ ::BE' PT O$i ;r7A3rT "A. IT� "TI[ES.
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Issued by
Date Completed Inspected B
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC- WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
co
Phone No.
Name of Firm
Boutin & Sons Const. Co. 623-2526
Address of Firm 121 Windsorville Road Broad rook, Conn
Location of proposed work a mer Drive
Describe fully nature of permit requested Strip e X t S 1 n g driveway, , if needed,
grade, roll an pave
Starting date Approx.time for completion
Call before you dig no. 52103181 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
j
Indicate North Prop. size of cut
No.cuts
Amt.of Deposit 8 by
O Cash O Check#
Cut size after Perm. Patch
No.Cuts
Final Billing S
Amt.Due Payee 8
Amt.Due Town 8
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: Y4'tw� Date: 5/25/05
Secretary .
Title: D.L.# ~
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Job Location:
-.
Description:
74Z-
Quote Good for 130 3 Days.
Special Attention: 1/2 Payment U on Starting, Balance Upon Completion. y'� 71( `
Contract Permit
ONE YEAR GUARANTEE ONAVORKMANSHIP & MATERIALS. I
CBUD
Date .
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