HomeMy WebLinkAboutDriveway Street Cut Permits 1019 Strong TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3298 Contractor CUSTOM PAVING
Location Address Address JOHN F JURGELAS
Type Work DRIVEWAY P.O. BOX 178
SOUTH WINDSOR CT 06074
e (860)528-2684
Date Insp Needed
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Time Insp Needed v3 b
Inspected By
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Permit No. 3298 Town of Sout
h W i ndso�r', CT
Date 05/23/2002 Street Excavation P mit
Expiration Date 05/23/2003
Descrip;
Applicant
f �� Location
Name CUSTOM PAVING , SRO ROAD
Addr. JOHN F JURGELAS � X
SOUTH WINDSOR CT 00� DRIVEWAY
Phone (860)528-2684 �
Applicant agrees h 'mod or the amount of bond
required and to reim u o th r any expenses
incurred by the Town a an pai i connection with this
permit and that appli an ide by the rules and
regulations for permi� 1 f th Windsor's Street
Cut Permit Manual . '
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* * PERMIT T 8 T LL TIMES. * �x
Issued by A �
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 $25.00
Name of Firm CU S-rc>m Phone No. ��`�R' -zx
Address of Firm t3 0-A. 1'7 S �-✓i,.�.a�..•.-
Location of proposed work /0 / 9
Describe fully nature of permit requested vt
Starting date Approx.time for compietion_. .
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
Hc� V C <�
No.cuts
AmL of Deposit$ by
O Cash O Check#
Cut size after Perm.Patch
No. Cuts
Final Billing$
AmL Due Payee$
AmL 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: Date: J I 4f `'d .�
Title:— l7 a D.L#•
PERMIT SHALL BE KEPT ON 70BSITE AT ALL TIMES
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