HomeMy WebLinkAboutStreet Cut Permit 5130unk Kupchunos 900077 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 07/14/09 t°
GIS ID: 51309999 FEE: 00
MUNIS APPLICATION# 200900806 EXPIRATION DATE:
APPLICANT <:LOCATION
NAME: CONNECTICUT WAfi1 R CbMPANY ATRE G( RI�IER<KUPCHUNOS &ELLINGTON RD
ADDRESS: 25 NORTH ROAD QWNER Tt3WN OF SOUTH WINDSOR
EAST WINDSOR,CT 0608$ " 1 4 LILLIVAN AVE
S INDS0R, CT 060742734
PHONE 860-623-3355
WORK DESCRIPTION: REPLACTIVG EIEIIN I7IAT-WeIAI�IAGET7 F3Y A MOTORIST
APPLICANT AGREES TO FURNISH THE TOWN OF 90UT Xj(� 5 IIBMprI:T OF BAND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY ?E SI 'ANGU£�T� >.B .THT'I O.: FOP'IvIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPtkAG-NT,IS`'FAII TLIP1 TWIT ND..WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF Sou-'. 3 I IT MANUAL.
ISSUED BY DATE SPECTED INSPECTED BY
7/14/20093:59PM ***'PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 9®®07 7
CONTRACTOR: C f A
LOCATION: CfJ Vl S
"1YPE OF WORK:_
DATE INSP NEEDED: DATE INSP: Z Z
INSPECTED BY:
WORK jN
PROGRESS:
ae 4,rA
AS-BUILT:
INPUT.--__CM DATE:__ j`/-D 9
WJ2007 Town of South Windsor INPSEMON REPORT 07
Jul. 8. 2009 3: 56PM CT Water Northern Reg ion'a- 1°"'u nd11 No. 2013 P. 1 wjuuz-I
Post-it'Fax Note 7671 bale 7 z/o9 �9"► / I -
To C'�'y rf0m Pam/ �o � SET EXCAVAT(ON.1'ERIU(iT
Co.roeP�• P �_ co• C�✓L SOUTH WINDSOR
Phoned Phan#�Zy'-33ScS' r 3ro9 RK5 DEPARTM9NT Pe--N
Fax# 6 y5� ?PAa Fax# )WIN FALL
-LIVAN AVENUE
N4SOR,CT 06074
' FEE $26.00
• -Name of Firm ca/J/joG r�cu.T /.c�a•rl� Co _Phone No. �3 �3��s' •
Addrss of Flan RD , ,c �L fi , a too
Location of proposed wof 77c C v
Describe fully nature of permit requested
6i l ovp/rl,ST_
Starting date is boo
Call eefora You Dig No, Z ob 1 Approx.time for completionW
Traffic Services Control No.
Show sketch of proposed work or feiml6h
two copies of sepa to drawing Indicate NorthFP7eni
s seeffo .n e fi ed oubY
of Saufh'Wind or't
Est:Size of Penn.Patch(s)
Est.PYL Thickness_In,
- kvACHvN��s �,e�✓� -
Est,Unit Price$ .
Amt"of Deposit
Total Due by
a ( )Cash( )Check#� -
Q1 P6nnanent Patch
No. Cuts
Size of Patch(s),
Final Bi I•
ng
v �� I Amt.Due Payee
S
AmL D'ueTown
L-
��iLEf� CaNGt rt' Ge 8y
Ap licant Is res onsible for contactlrt �•9�-�-
tha Police Lie t�.and C.R.I
1 AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT'OF BOND.REQUIRED AND TO REIMBURSE THE
TOWN OF SOUTH WINDSOR FOR ANY EXPENI INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THAT I AM PAWLIAR WITH AND WILL ASIDE By THE RULES AND.hEGULATIONS POP,
PERMITS AS O(JTLINED IN THE TOW F SOUTH WINDSOR'S STREET CUT PER IT -NUAL.
S[vgned• Date_7 G �
Trffe; �z E�sd Orlver's License M
PERMIT SHALT.SE KEPT ON J08SITE=AT ALL TIMES