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HomeMy WebLinkAboutInstall 2 aprons/driveway Street Cut Per • ! TOWN OF SOUTH WINDSOR INSPECTION REPORT Permit No, 3655 Location BETWEEN 100 AND FEDEX VACANT LTAddractOr QUALITY<PAVING CO. Type Work DRIVEWAY ens 90TR;ONG "ROAD SOUTH W'IND,5OR CT:,!06074 Phone No t8:O)523=i4182 Date Insp Needed ------------- D'ate Irn:s 4 p Time Insp Needed ------- --- Time Tnsp1 � Inspected By Work in Progress ------------ i ryr------------ a Input — ,..Date ..............��� Permit No. 3655 Town of South Windsor, CT Date 03/31/2004 Street Excavation Permit Expiration Date 03/31/2005 Descrip: Applicant Location Name QUALITY PAVING CO BETWEEN 100 AND FEDEX VACANT LT Addr. 90 STRONG ROAD SOUTH WINDSOR CT 0,6074<> T e `of Wo k DRI`VEA7AY Phone (860)523-4182 Applicant agrees: to furnish`the Town of South Windfiox the ,a,.mcunt of bond required and to refmb'urse t. iZdW4 o ot�th Tin sor fos''"arty expenses incurred by the Town for m'aintenanoe or repair work in tonryection with this permit and that applIcsnt 'is farnsliax fh will abide by the rules and regulations for permits as. outlined l;S? the Tsvtn of South Tlndsor's Street Cut Permit Manual. d. * * PERMIT TO BE KEEP.T ON JOB SII:E AT ALL:.. TIMES. Issued by j ��C Title -- -------------- f Date Completed .....—.....--... Inspected B � ��z" } APPLICATION FOR STREET EXCAVATION PERM �S IT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm �G` \ ` I q \VV r (' Address of Firm 6 Via lip Phone No. b Location of proposed work a iron c on bra e L4 r Describe fully nature of permit request d t m Starting date 6 v Approx.time for completion b Call Before You Dig No. O r, Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town of South Windsor two copies of separate drawing Pavement Cut Indicate North ^ Prop.size of cut No. cuts Amt.of Deposit$ by O Cash O Check# Cut size after Perm. Patch No. Cuts Final Billing$ 13 f J Fj Amt. Due Payee$ 4-r,n ©' X Amt. Due Town$_ Applicant is responsible for contacting � _ the Police De t.and C.B.Y.D. by date I AGREE T 0 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. (3;Signed: �.-- 3 __ / -�O 1 (� Date: l Title:_ �CJZ PERMIT SHALL BE KEPT ON 70BSITE AT ALL TIMES Standard Fonns\Pennits\Street Excavation Permit.doc w