HomeMy WebLinkAboutDriveway Street Cut Permits 61 Sunset Te TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3980
Location 0961 Cont..a,,a.t.y ., tTAfX PAVING CO.
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Type Work DRIVEWAY
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Date InsP N a
e e d ed
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ime Ins �,.
p Needed
Inspected By
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Permit No. 3980 Town of South Windsor, CT
Date 05/17/2005 "' °�'a2;,•,y Street Excavation Permit
Expiration Date 05/17/2006 "° Y
Descrip: REPLACE DRIVEWAY;
pplicant.
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Name QUALITY PAVING;4C0 'A F C�5f7 SUNSET--TER9Ac9
Addr. 194 S. MAIN ST2E 4 ��
EAST WINDSOR
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Phone (860)523-4182 x^'. y f'•
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Applicant agreds to 'ti s i the.::, h Wig: ~
3 :xx�s `• r' !wp �Qhvztaq€aunt of bond
required and to re r urs h Tta � £ r , qny xi xpenses
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incurred by the Tocnfrvmn ,p�nance or repair wo >:coraect1on with this
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permit and that a 3% 'an aim; ' y 3, aYs'fd b.,
PP t'`:is:::: f y ,the rules and
regulations for perm` is a>s'"Dud a s; '`.1' "' i',,of 'outh`:.yu� n:dsor s Street
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Cut Permit Manual. '
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PERINIT TOz;;BE .j�� OTC'"'[I9S:".:B: I"E'`A'P 'Pr>Ix 'TIMES.
Issued b
y
Date Completed ----__----- Inspected By
AF'I'LIGATION FOR STREET EXCAVATION PERMIT #S7g0
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm ' � � '�
Address of Firm
Phone No. ,�of 35�/��
Location of proposed work
1
L9 i
Describe fully nature of permit requested c'
Starting date
Call Before You D� Approx. time for completion (�`
g No. cI " �� Traffic Services Control NO.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate NorthO This section to be filled out by
Town of South Windsor
Pavement Cut
No.cuts
'q-
Est.Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$
C( � Total Due$ by
( )Cash( )Check#
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. 1-005-ot to (f 5�7 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:
Title: ��,�,�
Driver's License M 0'3 Q `7 a j_
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES