HomeMy WebLinkAboutDriveway Street Cut Permits 58 Wentworth TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 3` �3ROAD CT
Location WOW" 6
DRIVEWAY
Type Work �'hon��:.
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Needed ---------- `4y'" `
Date Ins Pam'
Time
s Needed
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r Permit No. 3693 Town of South Windsor, CT
Date 04/30/2004 Street Excavation Permit
Expiration Date 04/30/2005 <z' 4.^,
Descri
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Applicant , : , tin
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Name BOUTIN & SONS
YkS WENTWOR`:, :T:.:A#2TVE''„
21 WINDSORVILIE t.A' '::#+...,>;;::':.. :•aS•u::.>.
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OOK
OK CT'0 bd6 '
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Phone (860)623-25 2 6 i::...-:>::-
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Applicant agrees 't'o,`: Ev ' th}€ 1 e f:h Win'c:so; am unt o required an ;
re bond
q d to rem}surs'e the TcSntYi,�b ,� oYiY3S4x W a#�y ep�nses
incurred by the Town 'r tna h nanCe"'or @Saar 5+resr ection with this
permit and that a .i'C'a'rit" s:a£ MI.
PP xa , e ..bC1ze rules
„ Y .. and
regulations for perm$<ts as ctutlIHe'd`r,: n'th 2�e of Sou h Wsridsor s Street
Cut Permit Manual. x.
* * PERMIT
T6", E k P.T. ':>:7 �`:S.:kfF iV""AT,�kI�Ja` T..I S.
Issued b
e
Date Completed — Inspected
Job Location. OFF BROOKFIEM TROY RD
Description: l
i
Quote Good for 60 Days.
{ Special Attention: 1/2 Payment Upon Starting, Balance Upon Completion.
woaContract Permit
Cj �l�c
ONE YEAR GUARANTEE ON WORKMANSHIP & MATERIALS.
CBUD V� l� l Date
nnKFIELD, TROYRU
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC, WORKS DEPARTMENT
TOWN HALL �J
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Boutin & Sons Const . Co. a
Name of Firm 623-2526
Address of Firm 121 Windsorvi e Roa Phone No.
roa rook, Conn
Location of proposed work 58 Wentworth Drive
Describe fully nature of permit requested t r 1 p e X l s 1 n g r l ve wa r e s s wi
grade, roll and pave Y�
Starting date
Call before you dig no. Approx.time for completion
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing To be filled OUt b Town Of SO. Windsor
Pavement— — Cut
Indicate North
Prop.size of cut
------------
No. cuts
Amt. of Deposit S--by
()Cash ()Check#
Cut size after Perm. Patch
No.Cuts
Final Billing $
Amt. Due Payee -------------
S
Applicant is responsible for contacting Amt. Due Town S
the Police Dept. and C.S.Y.D.
-------------
by-_date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
SOUTH WJNDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED TOWN OF
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. H THIS
NED IN THE
Signed: 4/28/04
Date:
Title:
D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES