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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3469 Contractor BLUE DIAMOND PAVING INC
Location 0166 IBKYI:E W-1VE Address 1064 EAST ST NORTH
Type Work DRIVEWAY ,, P.O. BOX 273
SUFFIELD, CT 06078
Zo. (800)728-4644
Date Insp Needed s Cc D
Time Insp Needed
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Inspected By
Work in Progress
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Permi t"No. 3469 Town of South Windsor, CT
Date - 04/28/2003 Street Excavation Permit
Expiration Date 04/27/2004
Descrip:
Applicant Location
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Name BLUE DIAMOND PAVING Y DRIVE
Addr. 1064:EAST ST NORTH
r
SUFFIELD, CT 0607 RIVEWAY - -
Phone (800)728-4644
Applicant agrees t f or the amount of bond
required and to reim h r►irul r any expenses
incurred by the Town � �ai connection with this
permit and that appli arjZ ide by the rules and
regulations for permi S uth Windsor' s Street
Cut Permit Manual .
* * PERMIT TO ALL TIMES.
Issued by e
Date Completed Inspected By � —
APPLICATION FOR STREET EXCAVATIO �5y r N PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm���
Address of Firm Phone�e No. �
Location of proposed work--
Describe fully nature of permit requested ; ac
S i tr
Starting date Approx.time for completion
Call Before You Di NQ_3/ 7�� Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
l� Amt. of Deposit$ by
�C ()Cash()Check#
Cut size after Perm. Patch
No. Cuts
/ Final Billing $
,20 L g 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.
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Signed: e
Date:
Title: D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc