HomeMy WebLinkAboutDriveway Street Cut Permits 57 Rugby Lan TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3404 Contractor BOUTIN & SONS
Location S7-4,, ' Address 121 WINDSORVILLE ROAD
Type Work DRIVEWAY
BROAD BROOK CT 06016
hone No. (860)623-2526
r
Date Insp Needed t"
,�rr 8,d /e p._Ji oa
Time Insp Needed
Inspected By `
Work in Progress w
Date
Za
rmit No. 3404 Town of South Windsor, CT
te 09/26/2002 Street Excavation Permit
Expiration Date 09/26/2003
Descrip: ADD ON TO DRIVEWAY
Applicant Location
Name BOUTIN & SONS �` BY LANE
Addr. 121 WINDSORVILL
BROAD BROOK CT rk DRIVEWAY
Phone (860)623-2526 ".
Applicant agre sh indsor the amount of bond
required and to r 1M e ' So dsp for any expenses
incurred by the T i e r r in connection with this
permit and that a i th abide by the rules and
regulations for pe o South Windsor's Street
Cut Permit Manual . r
0
* * PERMI w E�' ALL TIMES.
Issued by A le
Date Completed Inspected By ,�,��
I;
l
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 I,
Location of proposed work
Describe fully nature of permit requested r
Starting date Approx.time for completion
Call before you dig no. � .lo GDr Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop size of cut
off' No.cuts
Amt.of Deposit S by
C>U'/r O Cash O Check#
Cut size after Perm. Patch
No.Cuts
Final Billing S
1 Amt. Due Payee $
Amt. Due Town S
Applicant is responsible for contacting
the Police Dept.and C.B.Y.D. by date
I AGREE TQ 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.
6,44k--
Signed: l/r ) (� Date: V
Title: �1 D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES