HomeMy WebLinkAboutWater Street Cut Permits 121 Pheasant Wa TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 2766 Contractor JMJ CONSTRUCTION CO.
Location 0121 PHEASANT WAY Address 658 ELLINGTON ROAD
Type Work WATER SOUTH WINDSOR CT 06074
Pk�Qn`e- No. (860)528-7889
Date Insp Needed 7�is�� Date Insp <,.7�i��99
Time Insp Needed S Tire Insp ^Gf`J-.,
Inspected By
Work in Progressr
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Pprml't No. 2766 Town of South Windsor, CT
Date 07/15/1999 Street Excavation Permit
Expiration Date 07/14/2000
Descrip:
Applicant . Location
Name JMJ CONSTRUCTION CO
Addr. 658 ELLINGTON ROAD r
` 1 FiEA4NT WAY
SOUTH WINDSOR CT I WATER
�-
Phone (860)528-7889
Applicant agreesVIn or the amount of bond
required and to re i mtuse ? e : 0� h e +`�r,--Fr any expenses
incurred by the Town :f � 'eni�� �r epai
�r A connection with this
permit and that app 1 rcant ," i de by the rules and
regulations for permits a °; °��, .. s,TQV i ;So�iGth Windsor's Street
Cut Permit Manual .
c
* * PERMIT TO BTI q ✓Ai_L TIMES.
Issued by �s-
�,..
Date Completed Ze
��"��Ins pected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No.
Address of Firm hM 446k fio
Location of proposed work
Describe fully nature of permit requested +� txit.
Starting date / Approx.time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be fil I I ed out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Er Lo Prop.size of cut
S �,V4✓� 0 No.cuts
A
Amt.of Deposit$ by
` {)Cash{)Check#
• '' Cut size after Perm. Patch
W
l No. Cuts
V j��;pJ�'a Final Billing$
_ ` s� l. ) .Amt. Due Payee$
Amt. Due Town$
Applicant is responsible for contacting by date
the Police Dept.and C.B•Y.D.
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: /`/S--yy
Title: D.L.#•
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permlt.doc