HomeMy WebLinkAboutStreet Cut Permit 20 Scott Drive Job Location: — / T f' d.
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.PLEASE NOTE: DUE TO CURRENT LATILITY OF LI IID ASPHALT PRICES.
CONTRACT PRICES W-ILL BE SUBJ-CT TO ANY PLAN MATERIAL CHARGES.
Quote Good for O6 Days.
Special Attention: 1/2 Payment Upon Starti alance Upon Completion.
Contract ,�
a Permit / �4- ��
ONE YEAR GUARANTEE ON WORKMANSHIP & MATERIALS.
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CBUD , Date
APPLICATIOON FOR STREET EXCAVATION PERMIT
N OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
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 Windsorville Road roa rook, Conn 06016
Location of proposed work 20 SCOtt Drive
Describe fully nature of permit requested c mr 1 ete did cult of 2xlgtip driveway,—dig- ut la;a;
CM _Q'. p� adrl r�rnnocc r'�kVg�Tgad®3—i;olI -and--�QV6. (�
Starting date 6�/�S�OR Approx.time for completion_�T�S
Call before you dig no. 20082302026 Ttaffic Services Control No.
Show sketch of proposed work or furnish TO be filled Out by Town Of So. Wind:
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit 8 by
(?Cash O Check#
Cut size after Perm. Patch
No.Cuts
Final Billing S '
Amt. Due Payee $
Amt..Due Town 8
Applicant is responsible for contacting
the Police Dept.and C.S.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 WJNDSOR 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: G` G ' Date:Title: �e G/G �li �`GJ D.L.# ~
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: 20V� iJ
LOCATION:_ A D S
TYPE OF WORK: \ �?
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 5.1)
WORK IN
PROGRESS:_ p
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AS-BUILT:
INPUT: G W\, DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
i
800082 7
PERMIT NUMBER �� T OWN OF SOUTH W I N D S O R, CT
STREET CUT PERMIT
DATE: 06/09/08 "_ �
GIS ID: 81600020
MUNIS APPLICATION#
200800833 ... E:
. : ..< >,. $ ,, CATION
f yw E ;l f m .. ... DATE: 06/09/09
APPLICAN •: 25.00
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NAME: `"�.:�:. .� :� ��.
BOUTIN&SONS :"r ;, . .$ .h OCATI ON
ADDRESS: 121 WINDSORVILLEO' s �`{ DRIVE
BROAD BROOK, CT 6�1 " , &
£ s 'U y
{ : :a: 4 RIVEN
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PHONE 860-623-2526 s = Ht.' y '' `-`' <.J D O
. .f ::3. <._Y _ S R,CT 06074
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WORK DESCRIPTION:
t
APPLICANT
AGREES TO FURNISH THE T
THE TOWN OF SOUTH WINDSOR FOR ANY �P F r Q
CONNECTION WITH THIS PERMIT AND THE AI? NS , ND UIRED AND TO REIMBURSE
. #R AINTENANCE OR REPAIR WORK IN
FOR PERMITS AS OUTLINED IN THE TOWN OF S `'. A n r ��ABIDE BY THE�Ha� ; RULES AND RE
Iy � ? �TEIIT MANUAL. GULATIONS
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ISSUED BY
DA E SPECTED
6/9/200810:30AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** INSPECTED BY