HomeMy WebLinkAboutDriveway Street Cut Permits 238 Skyline TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3470 Contractor BLUE DIAMOND PAVING INC
Location 093& SKYLINE VRI1 ' Address 1064 EAST ST NORTH
Type Work DRIVEWAY P.O. BOX 273
SUFFIELD, CT 06078
(800 )728-4644
Date Insp Needed s 10q
Time I nsp Needed
Inspected By
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Permit 1FRo.--_ 3470 Town of South Windsor, CT
Date 04/28/2003 Street Excavation Permit .
Expiration Date 04/27/2004
Descrip:
Applicant Location
Name BLUE DIAMOND PAVING Y DRIVE
Addr. 1064+ EAST ST NORTH
SUFFIELD, CT 06078 RIVEWAY
Phone (800)728-4644
Applicant agrees t u t S or the amount of bond
required and to reimb Me h r any expenses
incurred by the Town on ai I connection with this
permit and that appli a a ide by the rules and
regulations for permit fS th Windsor's Street
Cut Permit Manual .
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N d t
* * PERMIT TO LL TIMES.
SORO
Issued by e
Date Completed Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm /� �ui'nPbone No. 0 7a�• �/�5�f�
Address of Firm 6. 6d
Location of proposed work ykW
Describe fully nature of permit requested
Starting date 3' Approx.time for completion ( S
Call Before You Dig No4oS 3 J.2,6 (, Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Indicate North Pavement Cut
\b Prop. size of cut
�e No. cuts
J 6 Amt. of Deposit$ by
()Cash ( )Check#
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: e�� Date:
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Title: D.L.#•
PERMIT SHALL BE KEPT ON 70BSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc