HomeMy WebLinkAboutWater Street Cut Permits Tamarack Avenue TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4130
Location INTERSECTION W/TAMARACK AVE. Contractor SIMSCROFT ECHO FARMS
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Type Work WATER dress " P.O.:.gOg 581.;..,.
SZMSBURY CT 060^7.0
Phone too 6,5 31
Date Insp Needed
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Time Ins d
Neede
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Inspected Byji
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Work in Progress cc A
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Permit No. 4130 Town of South Windsor, CT
Date 11/30/2005 Street Excavation Permit
Expiration Date 11/30/2006
Descrip: EXCAVATION FOR WATER MAIN' CONNCTIQN"
Applicant LacatiO
Name SIMSCROFT ECHO FARMS Ij$�ERSECTION W/TAPLARACK';AVE.
Addr. P.O. BOX 581
SIMSBURY CT 06070 Type 'pf War;k WATER
Phone (860) 651-0231
Applicant agrees to ft�x:nish'.`the Town of oazth Windsor` the: amount of bond
required and to reitinb.ur'se the To o 0uth 't andsor fz Y,>any :ex;penses
incurred by the Towr. fQr m �nt ;nane b'r r�p:g. p work in b�tnection with this
permit and that appl' can't 'is fatii lacer ti �h A:3iC xa�l' aba de by'"th'e rules and
regulations for permits as, outZ.iTied In t34e 'T4w� o'i` Sou :3 Wzndsor's Street
Cut Permit Manual.
* * PERMIT TO '$E KC$:PT CSN cTClBIT AT ALL TIMES.
Issued by -----✓ PIE1`- ✓�
---------- Ti. le ) r �y
Date Completed e
----------------- Inspected BYGb<!r—
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_ APPLICATION FOR STREET EXCAVATION PERMIT 41 tee'
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
r. FEE $25.00
Name of Firm ,S!�S�rPorfl G�Ct - f ityf Phone No. 'Yho 6S-1oui/
Address of Firm 2 / lJ
Location of proposed work 7
Describe fully nature of permit requested 6'Xc4v417ia AAtgwlL it- 6i9f_j,�y/n
Starting date Approx. time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
D
Pavement Cut
IV l I No.cuts I
� I
Est.Size of Perm. P ch(s)
� `� �
Est. Pvt.Thickness in.
c
Est. Unit Price$
Amt.of Deposit$
S�— Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Ulu y�
Size of Patch(s)
Final Billing
$
Amt. Due Payee
v $
Amt. Due Town
BY
Applicant is responsible for contacting 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 A6IDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLINED IN THE TOWN OF SOUTH .WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: r_111-zu "V"----, Dater/
f
Title: Driver's License#: Lv v /"
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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ENGINE ERUNC,IMMIRTN E;NT - - ,
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