HomeMy WebLinkAboutWater Street Cut Permits 434 Pleasant Va TOWN OF SOUTH WINDSOR INSPECTION REPORT
/Permit No. 4341
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.• Permit No. 4341 . .,,,,u,,,,,,; Town of South Windsor, CT
Date 12/19/2006 Street Excavation Permit
Expiration Date 12 19 2007 Ya
Descrip: WATER SERVICE FOR;:>'NEW HOT: 'E;,; '•
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Name J & H SLATER CON`ST,.. CO:?.:-;::;'`:"' °: - .;.,-g' .q:'`g::• SA
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Addr. 75 COMMERCE WAY:
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SOUT
H WIN D SOR
6`:0 3¢
T��A�:e:•„R.��"`C�orki:.: �'.::ERt.'�: is
Phone 528- 5252 860 sus'�
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. tile ';Applicant a rees? to irai "s < ,:. ' e „?&fncunt of bond
required and t
q o reirEbur's.e`:` ha<.= octr,<
n s e s
incurred by the Towri>;;f o :;tit "i` apce+...oz«xe a'„x. on with this
permit and that appllicant ?s a' aiY[a 1 bde;:'by tAze rules and
regulations for permits a ou.Cl'ane.
F7ricsor's Street
Cut Permit Manual.
PERMIT TOE FCP 's£O.bI...Ji�:i'"S2"i AI'`<Af.L ::.TIMS.
Issued by
Date Completed _ Inspected By __-----
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL -
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
'y FEE $25.00
-Name of Firm �-� � �I'1
Phone No.
Address of Firm
Location of proposed work — - t
Describe fully nature of permit requested
Starting date Approx. time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or fumish
two copies of separate drawing Indcate North This section to be filled out by
Town of Sou th Windsor
Pavement Cut
No.cuts
LC Est Size of Penn.Patch(s)
lQ N G
Est.PvL Thickness�_in.
Est.Unit Price$ a z
IAmt.of Deposit$ f roll
I Total Due$ zs' by
( )Cash( )Check#f f 2
. i
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
34
Amt.Due Town
$
By
Applicant is responsible for contacting
the Police Dept.and C.B.Y.D. Date
I AGREE O FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN F OUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CO
CTI N WITH THIS PERMIT D THAT 1 AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMI S S UTLINED IN THE T WN OF S WINDSOR'S STREET CUT PERMIT MANUAL.
Sign
Date: 0
Titl V _ Drivers License
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
TOWN OF SOUTH WINDSOR v
ENGINEERING DEPARTMENT w
ADDRESS PERMIT NO. SHEET
OF
UTILITIES INSPECTOR TEMP.PATCH DATE
INSPECTOR COMPLETION DATE
TTT
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