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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4061
Location 0237 PIERCE ROAD Conto'r."C6VEN""eO.NSTRUCTION CO.
Type Work DRIVEWAY ftdre S €;`?:; P.O «:BQ3[•::42'7:.-
G ,ENTI Y C 06238
Date Insp Needed
Time Insp Needed " —`
Inspected By
Work in Progress F!. ��� �
In .t'
Permit No. 4061 Town of South Windsor, CT
Date 08/16/2005 Street Excavation Permit
Expiration Date 08/16/2006
Descrip:
Applicant LoCa,tiCan
Name COVEN CONSTRUCTION CO 0 � PIERCE #OAD
Addr. P.O. BOX 427
COVENTRY CT 06238 e of x+Iar�t TfR Vin. :
Phone (860)282-0526
Applicant agrees; td fuznlskx the Town of $'Mxtih WindSp the"araoaint of bond
required and to reimbu se; t ie Io m tsr any expenses
incurred by the Towa foi ...:.:.. .:. ::.. .::.:s<>:::....: :,.::..
Enaz;fit,`�rxariee`„nr>'rp3'i'r< 9c.;;;; x .rinect'ion with this
permi
t and tha
t a 1''
PP m Y, w� ... ri at a:bade by''tks'e rules and
regulations for ermi' s a 9 p s.. t'1.es"<To.WZ—&-of: .S`U
q t'h Warids'or s Street
Cu
t Pe
rmit
t Ma
nual.1.
* * PERMIT TO"BE KEPT ON se7ORI;T AT ALA; TIMES
Is
sued
d by
Date Completed Inspected B �Q
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm �'Q ,y (�.dam " �'fi Phone No. 6
Address of Firm Z l_1" ���"] d t® _ / T
Locati n of pr posed work G
U A 7
Describe fully nature of permit requested
Starting date_ d Approx.time for completion d` S
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South Windsor
Pavement Cut
No.cuts
Est.Size of Perm.Patch(s)
Est.PvL Thickness in.
Est..Unit Price$
Amt.of Deposit$
0
i Total Due$ by
( )Cash O Check#
{ Permanent Patch
a _ No. Cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
Amt.Due Town
By
Applicant is responsible for contacting 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 THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: �"
Date:
Title:_ �� ' � Driver's License#:ZZi I
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES