HomeMy WebLinkAboutDriveway Street Cut Permits 45 Petersen TOWN .OF OUTH fINCJSOR INSPECTION REPORT
Permit No. 3384 Contractor BOUTIN & SONS
Location 0045 PETERSEN WAY` Address 121 WINDSORVILLE ROAD
Type Work DRIVEWAY k ` BROAD BROOK CT 06016
aY Phone No. (860 )623-2526
Date Insp Needed Insp. 9'�?/ `Z-
Time, Insp Needed t I sp. ;00Fol
Inspected By
Work in Progress
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Permit No. 3384 Town of South Windsor,
Date 09/06/2002 Street Excavation Perm
Expiration Date 09/06/.2003
Descrip:
Applicant ° Location
Name BOUTIN & SONS PETERSEN WAY
Addr . 121 WINDSORV
BROAD BROOK o Work DRIVEWAY
Phone (860)623-25
Applicant a 036 rn �u h Windsor the amount of bond
required and t e of sor for any expenses
incurred by th r m � e o a� r� ork in connection with this.
permit and tha v �.
. lid will abide by the rules and
regulations for a uh o of South Windsor's Street
Cut Permit Manu 1
I;
* * PE R, E AT ALL TIMES.
Issued by e9' T it 1 e ,�,. ,,.
� f
Date Completed Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC, WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Boutin & Sons Const Co. Phone No. 623-2526
Address of Firm 121 Windsor ri 1 1 e Road Broad Brnnk r Conn 06016
Location of proposed work 49 -P n t a r g a n Wa v
Describe fully nature of permit requested Stria Existing DriyL-wny drpsg with nro cess gravel
grndl roll and lava
Starting date Approx.time for completion
Call before you dig no. 2.0023 501 701 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 $ by
() Cash() Check#
Cut size after Perm. Patch
No.Cuts
Final Billing $
Amt. Due Payee S
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 REIMBURSE 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: �� ��e /� / D.L.#
PERMIT SHALL BE KEPT ON JOSSITE AT ALL TIMES
I1ny n �� + 25 . 00 permit fee
Job Location:
R
Description:
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Quot�G�o or 60 a;s. • ' '• '•
Special e ion: 1/2 Payment Upon Starting, Balance Upon Completion.
Contra Permit
ONE Y R GUARANTEE ON WORKMANSHIP &MATERIALS. / VbG�•r� _ Pres.
7
CBUD o b Z' �6 1 Date .Se jO Z d