HomeMy WebLinkAboutStreet Cut Permit 108 Birch Hill Drive 900038
PENT NUMBER TOWN OF SOUTH W I N D S O R, CT
: . .,.. STREET CUT PERMIT
DATE: 04/29/09 " . g ,
GIS
11400108 h
APPLICATION sw y ; *-' >.< <x. ». a
MUNI # 200900410 FEE: 25.00
: ,
,s ) Y. 3' E kRATION DATE:
04/29/10
APPLICANT �� rz t ry
Y- qt y .4
NAME: M&S PAVING AND , F LOCATION
ADDRESS: 435 BUCKLAND ROG RE$5 FZg BIRCI HILL DRIVE
SOUTH WIND$OR, k tams ROBERT&MEAGHAN C
Q. hsIR-c HILL DR
860-648-1915
fi SOR,CT 06074
PHONE
WORK DESCRIPTION: DRIB 5.
APPLICANT AGREES TO F URNISH THE'IkQ ,F�, IJT_H�THE TOWN OF SOUTH WINDSOR FOR AN I� MQT BGND REQUIRED AND TO REIMBURSE
CONNECTION WITH THIS PERMIT AND THE
EC. .
�0 0 .14IAINTENANCE OR REPAIR WORK IN
T. 5 R' VIHND. L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO WN OF Y
° ." FT ,R IT MANUAL.
ISSUElWy iDATE INSP CTED
4/29/2009 9:I2 AM *** INSPECTED BY
PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT'NO.: °1 a60.3g_ CONTRACTOR: Q-,S v
l 1J
LOCATION: 1 o R �, µ , 1 I
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: r a o
- V _ INSPECTED BY:_SLR—.
WORK IN
PROGRESS:
------------
AS-BUILT: .
INPUT: CrV`� DATE:
W/2007 Town of South Windsor iNpsEcaoN REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT " ��� 8
TOWN OF SOUTH WINDSOR Permit Na:
PUBLIC WORKS DEPARTMENT
TOWN HALL
IUO SULLIVAN AVENUE'.
SOUTH'WINDS,OR, CT 0607_4
I ,S
FEE,$25.00
Name of Firm �
fl 1�/?ta I Phone Na itu,. c .�'
Address of Firm
Location of proposed work
Describe fully nature of permit requested nF I yLw
Sfarting date_
y Approx.time for completion_ "
Call Before You Dig No._ Traffic Services ControM
Show sketch of propo77
sed work or furnish "
two"copies of separate.drawing Indicate North This section to.be filled out by
Town of South Windsor
Pavement cut
No.aft
Est Size of Perm. ,atcN
Est P14 Thickness Est.Unit Price$
Total Due$ by f
e s
Pennanent Patch'
No._.Cuts
Size of Patch(s)
Finaf Billing
Amt;Due Payee
$
Amt:.Due Town
By
Applicant is responsible fior contacting "' Date
the Police De t.and C:BY:D...
1 AGREE TO FURNISH TO THE TOWN OF SOUTH 1NINDSOR,THE AMOUNT OF BOND REQUIRED AND TO REIMBURSEHE
TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN;FOR MAINTENANCE OR`REPAIR;NORKL;IN
CONNECTION WITH THIS P MIT'AND THAT I AM FAMILIAR WITH AND.WILL ABIDE BY THERULES'AND REGULATIONS'FOR
PERMITS SOU INED E TOWN OF SOUTH�WINDSOR'S STREET CUT PERMIT MANUAL:_
Signed:
Date: w
Title: -Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES