HomeMy WebLinkAboutDriveway Street Cut Permits 5 Vintage La P TOWN OF SOUTH WINDSOR INSPECTION REPORT
RUCTION (JOHN)
Contz.a ' 'tir JPCQU 'S'°;: gNST
4209 67 RIDGE ROXD
Permit No. dresS
06074
Location 004, Sf�UTH FIINBOR CT
Type Work DRIVEWAY Ptio 3g32-1923 !
Dat
Date Insp Needed _— ---- — ! {o
Time Insp Needed ________——
Inspected BY
Insp
Work in Progress -----
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Town of South Windsor, CT
' 4209
Street Excavation Permit
Permit No 05/04/2006
Date
05 0 /
g 2007
Expirat
ion
Date
/
De DRIVEWAY CUT ,ocatad
Applicant
JOHN)
0005 V�NTAGE.'I.ANE
Name JACQUES CONSTRUCTION ( ➢ I�IEWRY
�� off:War
Addr. 67 RIDGE ROAD 0fi074
SOUTH WINDSOR CT of bond
Phone (860)432-1823 f Satl Wind�ox ,thee att1ount
sh the Tc+w do ehses
to fur%? gar: �xp
a rees fpuCk�,, ;: tidn with this
Applicant g tieow Gt 3n �bnnEc
to rei�burse ,'` or,:;.:r:;pa<1';r:z.worl� ..: :.. ae by tY"e rules and
required and fox m? 3essance
Town, w; t� 33t1 wll`. a Street
incurred by the leant i; "famll�arAWy.,,of Sc�uth ,Wzndsor's
permit and that aPP oitl�ned 1y� 'thy„
regulations for permits as
Cut Permit Manual. T2M.E'$•
* * PERMIT TO B$ KP ' ON JO$ SFR pT, ALL
Issued by
Inspected By
Date Completed ------------`--
:4 APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm �,��
Address of Firm Phone No. 3 l S
Location of proposed work �,vrAU� L uL
Describe fully nature of permit requested to
Starting date e)
Call Before You ig o. Approx. time for completion
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South Windsor
Pavement Cut
No.cuts
/ I Est.'Size of Perm.Patch(s)
Est.PvL Thickness in.
Est.Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Pennanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
Amt.Due Town
By
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Applicant is res1ponsibie for contacting
the Police De t.and C.B.Y.D. Da
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 REPAIRWORK IN
CONNECTION WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS UTLI IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title:
Driver's L cense#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES