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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 2821 Contractor JDC ENTERPRISES INC.
Location 0030 WINDSHIRE DRIVE Address 2640 BERLIN TNPKE
Type Work STORM NEWINGTON CT 06111
Phone No. (860) -
Date Insp Needed Date. Insp.:;, C5 9
Time Insp Needed TvMe, Insp
Inspected By
Work in Progress ( ,�;e% - C� ,c" , c�, ►c ,s,J
c Z<
lnpot� >= Date `i'
Pe mit 'No. 2821 Town of South Windsor, CT
Date 08/17/1999 Street Excavation Permit
w. .
Expiration Date 08/16/2000
Descrip: ROOF DRAIN CONNECTION
Applicant Location
Name JDC ENTERPRISES INC. 0S0 =WINSHIRE DRIVE
Addr. 2640 BERLIN TNPKE
NEWINGTON CT 06111 'Ty' o Of Wor'R STORM
Phone (860) -
Applicant agrees S-buth,Windsor the amount of bond
required and to re i mbu use '; � own _ :,� I� d ar'-for any expenses
incurred by the Town f`c�r ►rC�nena � �.;repa� rWrk�� in connection with this
permit and that applicant, . farm Trtar its and�,,Wl, l bid by the rules and
regulations for permit ass< oU tk� 1n4d i� a Town � f �, outh Windsor's Street
Cut Permit Manual .
* RMIT TO�, P ?N J IT AT 'AL"'
L TIMES.
Issued by 'a ICU`)'�.�
Date Complet _ nsoected By _
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT vZ
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORf CT
FEE $2S.00
Name of Firm "'"'�.a�.C: - '" �� g�S, Z.-C, Phone No �G'7--y��
Address of Firm a .-f
Location of proposed work vL
Describe fully nature of permit requested w,J
Starling date / Approx.time for Completio JDAjS
Call Before You Di No 2 g . 7 Traffic Services Control No.
Show sketch of proposed work or furnish To be fined out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut � �?
• 20�
No.cuts
Amt.of Deposit$ by
O Cash()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
�►+�3 Amt. Due Town$
Applicant is responsi[1efor 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 SOM WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: .
Title:
D.L.#• __ ��
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc