HomeMy WebLinkAboutDriveway Street Cut Permits 170 Valley V i,/
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No., 796 Contrac't'o SONS
Location 0170 VA11$'$ V,19W DRIV Addiress F<::;'•21 i^J'IND ORFT. LLE ROAD
Type Work DRIVEWAY `gROAfS BRQOy CT"'q.;6016
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• Permit No. 3796 Town of South Windsor, CT
Date 07/14/2004 Street Excavation Permit
Expiration Date 07/14/2005
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Applicant Location
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Name BOUTIN & SONS 'i� f Vt{LLE ''VT�T DFtI
Addr. 121 WINDSORVILLE ROSQ BROAD BROOK CT 05016Work...,'77R• bTWAY
Phone (860)623-2526 x
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Applicant agrees to, fitr l t 'G-he a Ftt s h WiE' the amount of bond
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required and to reip urs ,the down of NoYt i. T9 sor r,,.., n x e ses
incurred by the To fox- �nance a A.F:';gar .ii ork i� ��ranee�;ao� with this
permit and that applicant f m 12 � ... ixall qb-d' by , rules and
regulations for perjts;';a '' tfI` x�ed in 'the T,ownof:::: `'orti' ;Ai ,d.,,so: 's Street
Cut Permit Manual. ^Jr�.�;•F >:�;::
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Issued by
Date Completed
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. . APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT 3
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
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Boutin & Sons Const. Co. 623-2526
Name of Firm
Address of Firm lri sorvl e roadPh e
Location of proposed work 170 Valley View Drive
ont
Describe fully nature of pe mit requested g driveway a grave , gra e, roll
and pave
Starting date Approx.time for completion
Call before you dig no. 20042802610 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of So Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt. of Deposit$ by
() Cash()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing $
Amt. Due Payee $
Amt. Due Town $
Applicant is responsible for contacting
the Police Dept.and C.B.Y.D. by date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF
SOUTH WJNDSOR 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: 7/9/04
Title: �� �-1 D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
• Description:
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Quote Good for 60 Days. `
Special Attention: 1/2 yment U on Starting, Bala ce Upon Completion.
Contract �t) �`
Permit
ONE YEAR GUARANTEE ON WORKMANSHIP&MA
TERIALS.S.
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CBUD Zo % Z Date / d
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