HomeMy WebLinkAboutDriveway Street Cut Permits 45 Ridge Roa ' TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3484 ,:.; ;:<.; :,
Cont:rd'c'tor CUSTOM'., `°PAVING
Location 0045 RIDGE ROAD
Type Work DRIVEWAY Address; JOH�3,F, :J:URGL'LAS
I78.
7'-vTH WI:NDSOR CT 06074
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Date Insp Needed '. ii. .� —
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Time Insp Needed
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Txme Insp '
Inspected By
Work in Progress -- �
Input _�11L`' Date _jl
Permit No. 3484 Town of South Windsor, CT
Date O5/08/2003 Street Excavation Permit
Expiration Date 05/07/2004
Descrip: CK 6755 $75.00 3 PERMITS
Applicant Location
Name CUSTOM PAVING O64S RIDGE R�ILD.:
Addr. JOHN F JURGELAS
SOUTH WINDSOR C' 06074 T p.e of ye�r}E DE2IV$WAY
Phone (860)528-2684
11
Applicant agrees to fiirnish''the Tow ,' f.: South Wind�6r, the! amqunt of bond
required and to reimbur"se the .Iown p Sough WdSor. for any%expenses
incurred by the Town fcr'r mejUaGenanceor repair work Yn conn�ecti;bn with this
permit and that applicant is ga" J.1xat witiY asyd Ca 11 ab'ice by the rules and
regulations for permits as outs ined its the.Towt}. of s Street
Cut Permit Manual.
* * PERMIT TO $E KP OIL"c�B .SI, E 'AT;..AFL TIMES.
Issued by
Date Completed Inspected By
3 Y�
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORf CT
FEE $25.00
Name of Firm_ �- U fi o vY. �,q y Phone No.__ �
Address of Firm I—7
Location of proposed works,¢—
Describe fully nature of permit requested
Starting date__�-z—_> r, Approx.time for completion
Call Before You Dig.No. Z2 o_ 'tc 12,02 9 A",-Trafryc Services Control No.
Show sketch ofproposed work or famish
s
two copies of separate drawing To be filled out by Town of South Windsor
Pavemen c'9
Indicate North Prop.size of cut
No.arts
Amt.of Deposit$ by
()Cash()Check#
rtO Cut size after Perm. Patch
No. Cuts
Final Billing $
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:_ ,i.�__�,c� s�,g2 Date:_ 7—Q
Title: d-a D.L.#:
PERMIT SHALL BE KEPT ON 306ME AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc