HomeMy WebLinkAboutMiscellaneous Street Cut Permits Pleasan (3) TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4056
Location PLEASANT VALLEY & CLARK INT. `
Conk• : or UN Jk CONSTR.
SERVICES
Type Work MISCELLAN 4iidrep ' 290.` UIOP'E;,,,AVE.
1d.ARTFOIP3 6
XX
Date Ins
p Needed
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Time �"
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i Permit No. 4056 Town of South Windsor, CT
Date 08/03/2005 r•<•r `a`"^ "' Street Excavation Permit
Expiration Date 08/03/2006
a ,46
Descrip: TEST PITS FOR TELF,40T7Bt
01
Applicant •f" x $
Name UNDERGROUND CON,5TR. ""SERV•I'CB '' SANT VAlif,13Y. &' CL RK ,INT.
Addr.. 2
90 HUYSHOPE i` "'�'�¢^k, •'=.`>y��f:%+y q, '��;\Y
HARTFORD CT 06I05; 'I� pe xat1� 1 Tuk:tin.2.�f7
Phone (860)524-8984 s r x r '.w, .• �,,,, .:
Applicant agreed tib•,frxfa skt the T 'i>; € WinC�ta3 t1s adncaunt of bond
required and to reiKtnbYts ;;t,.} � "gpr .x-<>a3y,,�x. nses
incurred by the Towsna 'Yk,'U�hna !ctibn with this
permit and that apP daevt
�i'44,& ,by lthe rules and
regulations permi ' ,
:�6for is a c�aa 7 s idSor's Street
Cut Permit Manual. / "
* * PERMIT TO`sa$E.=rF 'PT."CJ1V^> F ,: '? Y'"::p .<>T`IMS.}`st
Issued b
Date Completed _ Inspected Bye-t��=
APPLICATION FOR STREET EXCAVATION PERMIT yO3
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm `V C j y i Phone No.—a
Address of Firm_
Location of proposed work r"'i I(~ i !
Describe fully nature of permit requested T); i , Z, Lf, `
Starting date :.7' -c Approx. time for completion It>-•l—
Call Before You Dig No, .Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
. s No.cuts
J
Est.Size of Perm. Patch(s)
J
Est. Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
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 IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: _
' Date:
Title: c Driver's License#: '
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES