HomeMy WebLinkAboutStreet Cut Permit 245 Fairview Drive I 900
094
PENT NUMBER
TOWN OF SOUTH WINDS
DATE: 07/27/09 '���" R, CT
GIS ID:31500245 _ - STREET CUT PERMIT
MUMS APPLICATION# 200900867
FEE:
APPLICANT MIRATION DATE: 25.00
NAME: -
QUALITY PAVING 07/27/10
ADDRESS: ING Co =
194 S.MAIN STREET al LOCATION
EAST WINDSOR, CT- StOt; g RIW&" _25 FAIIVIEW-IV DR
PHONE CAIL D
860-523-4182 - _4 FAQR IEW DIVE
fi
CRIPTIO
INDSOR CT 06074
WORK DES N: DRIV Zr
APPLICANT AGREES TO FURNISH I X
THE TOWN OF SOUTH THE T&WI OR FOR ANI� Xp '
CONNECTION WITH THIS LF SD FOR PERMITS AS O PERMIT AND T F AND
LINED IN THE TOWN 'PIF1E � I3IAINTENQANCE OR REPAIR D AND TO REIMBURSE
WN OF ITT L" S �T tlik L WORK IN
S STRE ABIDE BY THE RULES AND REGULATIONS
IT MA
ISSUED BY _
7/27/2009 10:46 AM *** PERMIT TO BE DAT IN PELTED
KEPT ON JOB SITE AT ALL TIMES*** INSPECTED By
TOWN OF SOU't'N WZNDS4it INSPE
- E'�'ON REPORT -
PERMIT-NO.: Qoff
LOCATION: CONTRACTOR:
s- v l
TYPE OF WORK: r V,.e .
___-- ..DATE INSP NEEDED:
INSPE-GTED_BY.
g� DATE INSP:
�/c
WORK IN
PROGRESS:
Qm, S G
AS-BUILT;
INPU .-
DATE: (7
W/2007 Town of Soutfi w INPSEC[TON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
'PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
Name of Firm . FEE $25.00
Address of Firm
_ Phone No.
Location of proposed work
Descr' a fully nature of permit requested
St rting date
Call Before You Dig o. 06 Z Approx. time for completion_ '
� �� �3� Traffic Services Control No.
Show sketch of proposed work or famish two copies of separate drawing
Indicate North This section to be filled out b
Town of South Windsor
Pavement Cut
No.cuts
Est.Size of Perm.Patch(s)
Est.Pvt.Thickness
in.
Est.Unit Price$
Amt.of Deposit$
c
Total Due$
' by
/ ( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
1 Amt.Due Payee
$
�j /// Amt.Due Town
V� f % $
Applicant is responsible for contacting y
the Police Dept.and C.B.Y.D.
Date
I AGREE TO FURNISH TO
TOWN OF THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FO
CONNECTION WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDETHE RULES AND REGULATIONS FOR
PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT BY R MAINTENANCE OR REPAIR WORK IN
MANUAL.
Signed: n
1C
Title: Date:
'ERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Driver s License#: