HomeMy WebLinkAboutStreet Cut Permit 43 Stevens Road APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC• WORKS DEPARTMENT
TOWN HALL 3ppo -�,s
1540 SULLIVAN. AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Boutin & Sons Cons t. Co. Phone No. 623-2526
Address of Firm 121 Windsorvi e Road roa rook, Conn
Location of proposed work 43_ Stevens Rnnd
Describe fully nature of permit requested Saw r-1 it.and rPrlr_ .o t. �0arl
Starting date 6/5/08 Approx.time for completion C;ma
Call before you dig no. 20082102201 Traffic Services Control No.
Show sketch of proposed work or turnish ` o age filled out by Tom OP CO Wind,,
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
No.cuts
4 Amt.of Deposit S by
O Cash O Check#
Cut size after Perm. Patch
' No.Cuts 111
/o AI Final Billing$
Amt. Due Payee S
Amt,Due Town $
Applicant is responsible for contacting '
the Police Dept.and C.B.Y.D. by date
1 AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF
SOUTH WJVDSOR 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: a "O
Title: �G�G/e %�
D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:_2�C-I's CONTRACTOR:_ lS xk+ l I�
LOCATION: `\ 3Al
TYPE OF WORK: `f
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:_ T)
��--
AS-BUILT:
INPUT: Cam- DATE: " D
W/2007 Town of South Windsor INPSECTION REPORT 07
800075 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/29/08 �
GIS ID: 85900043
MUNIS APPLICATION# 200800761 � `
, :y:fry '~ FEE: 25.00
° > t >n ,' ,•` ..:: I>RATION DATE: 05/29/09
CANT ON
NAME: BOUTIN OCATI
&SONS ' v :, S ..:.. TEVEIS RD
ADDRESS: 121 WINDSORVILLE 16 ° ,„ '
�LLIAM A&LISA P
BROAD BROOK,CT 6t f A i ;: �,.:M: .
�; :<, . � ^x .�VEND ROAD
I-PlffMSOR,CT 06074
PHONE 860-623-2526 ```' •r "` !x: '' ?
.'
WORK DESCRIPTION: DRIVI W Y `
APPLICANT AGREES TO FURNISH THE T `. S`�L,#TH 0 B3 REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYNE x1TTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPA ' '.I`Ts , .: II`"•I 2L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S r T. IMANUAL.
4/10 1 l0q
ISSUED BY DATE IN FECTED INSPECTED BY
5/29/2008 12:11 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***