HomeMy WebLinkAboutMiscellaneous Street Cut Permits Woodsid 03 TOWN OF SOUTH WIN[D�SOR INSPECTION REPORT
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Permit No. 3082 Contractor M. J . D. CONSTRUCTION CO.
Location INTERSECTION OF # =�, Address 26 MONTROSE ST
Type Work �MISCELLAN � P(kgSANT VAIN P4 HARTFORD CT 06106
/� Phone No. (860)953-8025
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Date Insp Needed 4116 ��) . Oa' te,. Insp.
Time Insp Needed CA. . T�ine 'Irtsp.,
Inspected By
Work in Progress ,-�
Input ( Date �� ��
Permit No. 3082 Town of South Windsor, CT
Date �_"0 1 1112001 Street Excavation Permit
Expiration Date 04/11/2002
Descri-p: INSTALL PERMANENT PATCH FOR MDC
Applicant Location
Name M. J . D. CONSTRUCTION CO. TN`TIERSECTION OF
Addr. 26 MONTROSE ST
HARTFORD CT 06106 T"ype""bf if rk MISCELLAN
Phone (860)953-8025
Applicant agrees ctn►t#,,caf Scauth Windsor the amount of bond
required and to reimburse' ;the Town.,n S tith W1 n°d'sor for any expenses
incurred by the Town for rr -7,n"tenanze +rrr,' repa'i!r w+prk in connection with this
permit and that app l i'cant':i:s. f am1' i ar W"i th and ire- 1 Y abide by the rules and
regulations for permits as ttt.l_ ec `',TA,''G�ie, Town ;ref:South Windsor's Street
Cut Permit Manual .
* * PERMIT TO BE K,EP"T`t'4` ,1US :.SIT : AT ALL TIMES.
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Issued by Jam. � ��A T i-t'l,e -_ ;c cc�
Date Completed _ D� __� Inspected ByG
308S
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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 $25.00
Name of Firm C d
Address of Firm o y
Location of proposed work ij rQ P
Describe fully nature of permit requested
Starting date U L/— I — o i Approx.time for completion 3 0 aye
Call Before You Dig No.;�2 og2 I f 1:0 13 5-f Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
O Cash O 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 WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: /7 1/—
Title: ',q
PERMIT SHALL BE KEPT ON 306SITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
SOUTH WINDSOR r
BITUMINOUS; 99-13,2001
DATE BITUMINOUS
NO. COMP. LOCATION SEAL DIMENSIONS "
INSPECTOR, STEVE JINGST
278-7850 EXT. 3623, (emergency EXT. 3600)
o
1 WOODSIDE DR. @PLEASANT VALLEY RD. 20 352.8 00 X 11.00
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