HomeMy WebLinkAboutMiscellaneous Street Cut Permits 164 Sky TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3713
Location 0164 SKYLINE DRIVE Cont.ra'Ctor COSTA'"'&>::;SON, LLC
Type Work MISCELLAN Acidre P 03 BOX 65'8:.
SOUTH WIIdTISOR 'C: 06074
Phone-.,No«:t86�3}644 24.,99
Date Insp Needed ,
baCe
Time Insp Needed
T.
Inspected By
Work in Progress _ Gh�Gc7D/
Date
Permit No. 3713 Town of South Windsor, CT
Date 05/20/2004 `" Street Excavation Permit
Expiration Date 05/20/2005
Descrip: SIDEWALK
Applicant Locaeion
Name COSTA & SON, LL( 0364 SKYLINE DRIVE
Addr. P.O. BOX 658
SOUTH WINDSOR 6r Q6074 fi e ca„ :Wth k L43ISCEILAN
Phone (860)644-2499
Applicant agrees t'o'...f '4WI the ,Tower, bl..t>h Winclso the amqunt of bond
required and to reinbunse tS� ;. Towwn atouh YTridsea.r Dior any expenses
incurred by the Town o'r ma Xltenanc'e or 'epair""wbr)c i•n &64ctt6n with this
permit and that appl'ioant �s :xa�iisar wb ;arse "will,abzde ::by the rules and
regulations for permi',s as. Outlines zn the �fJ n' qf SouthW; :ndsor's Street
Cut Permit Manual.
* * PERMIT TO'BE;i PT ON 'LIOB SITE'AT ALL.,TTMES.
Issued by —`t}----- 2'itle' ��
Date Completed Inspected By
/Arrut;A11UN FOR STREET EXCAVATION PERMIT 3*747
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm 10 O .S T �j v„� L L Q (/
Phone No. _
to y `1 a y S
Address of Firm 01 54- 3
Location of proposed work `
Describe fully nature of permit requested 6 e rn D aQ 'a c e t
(2,o yt C,r e 4-,e <, e a� k ' /
Qs !�� L.e �t 7�aQ ow f S C,Ji s r
Starting date 5 do pprox. time for completion
Call Before You Dig No, Traffic Services Control No.
Show sketch of proposed work or fumish
two copies of separate drawing Indicate North This section to be filled out by
Town of South Windsor
Pavement Cut
No.cuts0 o'
Est.Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est. Unit Price$_ �✓/,�
Amt.of Deposit
Total Due by
( )Cash( •11�heck# ?�y�
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt. Due Payee
Amt. Due Town
By
Applicant is responsible for contacting
the Police Dept.and C.B.Y.D. Date
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: a-d Oy
Title: r e,.—
Driver's License#:_ j— J 9 a 1,f 7 3,;�JC-
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
fSJv�`'1.'or-S(svTFl 1VINI?SOF? Ar
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