HomeMy WebLinkAboutDriveway Street Cut Permits 164 Skyline TOW14 OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 3447 Contractor BOUTIN & SONS
Location Address 121 WINDSORVILLE ROAD
Type Work BROAD BROOK CT 06016
„ Phone No. (860 )623-2526
Date Insp Needed a is O
Time I nsp Needed S Pfi
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Inspected By
Work in Progress 0
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Date
Pe;gbit No. 3447 Town of South Windsor, CT
Dalis 04/01/2003 Street Excavation Permit
Expiration Date 03/31 / 004
Descrip: INSTALL DRIVEWAY
Applicant Location
Name BOUTIN & SONS „ 4 Y NE DRIVE
Addr. 121 WINDSORVILLE ROA
BROAD BROOK CT 0 01 DRIVEWAY
Phone (860)623-2526
Applicant agrees h 'nd or the amount of bond
-
requ fired and to reim r wn r any expenses
incurred by the Town n } pa connection with this
permit and that, appl ami an 1 ide by the rules and
regulations for perm To th Windsor's Street
Cut Permit Manual .
* * PERM T = A TIMES.
Issued by h �• �NG
Date Completed pected By
APPLICATION FOR STREET EXCAVATION PERMIT *J 44;77
TOWN OF SOUTH WINDSOR
PUBLIC- WORKS DEPARTMENT
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE 25.00
Name of Firm + S
Address of Firm Phone No.
Location of proposed work ,
Describe fully nature of permit requested
Starting date Aoorox time for
Call before you dig no. f l I c :4�a Services s completion
ro No
—�---�r� Traffic Services Control No.
Show sketch of proposed work or furnish TO be fll@�] out bV Town-of SO ' Windcnr
two copies of separate drawing
Pavement Cut
Indicate North
G�
Prop.size of cut
No.cuts
Amt.of Deposit S by
O Cash O Check#
Cut size after Perm. Patch
No.Cuts
Final Billing$
Amt.Due pay.,=
Applicant is responsible for contacting Amt.Due Town S
the Police Dept. and C.B.Y.D.
by date
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I AGREE TQ FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF
SOUTH ADSOR 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: o
Date:
Title:
D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES