HomeMy WebLinkAboutStorm Street Cut Permits 205 Tumblebrook M
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 2902 Contractor GERBER CONSTRUCTION CO
Location 0205 TUMBLE BROOK DRI Address 616 DART HILL ROAD
Type Work STORM VERNON CT 06066
Phone -,No. (860)875-6684
Date Insp Needed Date Insp; 1 -7
Time Insp Needed Time Irsp.�` eca
Inspected By
Work in Progress 4-6ix, Afcss ?�,
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Input Date I wl,-Z)
PA.rm1-tA N0 2902
Town of South Windsor , CT
Date 01/07/2000 Street Excavation Permit
Expiration Date 01/06/2001
Desdrip: WORK FOR TOWN C. B. REPAIR
Applicant Location
Name GERBER CONSTRUCTION CO 0205 TUMBLE BROOD. DR!
Addr . 616 DART HILL ROAD
VERNON CT 06066 Type of 'Mork STORM
Phone (860 )875-6684
Applicant agrees to f°urnlshµthe Tgwn 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 applicant is familiar with and will abide by the rules and
regulations for permits aa outlined in the Town of South Windsor ' s Street
Cut Permit Manual .
PERMIT TO BE KEPT ON :JOB SITE AT ALL TIMES.
Issued by --— Title
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Date Completed _.--- ate-' 4 � --- Inspected By �4via ----
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $2S.00 _
Name of firm Gn-46x / Phone a N
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Address of Firm &6 49m.1 Rill
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Location of proposed work r,
Describe fully nature of permit requested
Starting da Approx.time-for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To,be fifle�d out by Town of Souith Win r
two copies of separate drawing
Pavement ut ,f
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ 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 WI DSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: A ��
Title:— � D.L.#: 3d
PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc