HomeMy WebLinkAboutStreet Cut Permit 434 Pleasant Valley Ro TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4312 Cont.va„ctor J�&x H`'SLATER CONST CO
Location 434 PLEASANT VALLEY ROAD A'+i�`clres;�� a75 (ZtiMM;..'RCE�"WILY
Type Work SAN MAIN t.'"� gF 'jh U' WIND OR C : 06074
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Permit No. 4312 Town of South Windsor, CT
Date 10/06/2006 -:j''" M Street Excavation Permit
Expiration Date 10/06/2007 „..„ `.;;, ' 'A
Descrip: STREET CUT FOR SALTIIMAIN`-- T' „i3d?P.f``�>>T
Applicant ,IocCt.
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ASAN Name J & H SLATER CO ST 'CO' ,. .t, . . A LFX ROAD_
Addr. 75 COMMERCE WAYJ
SOUTH WINDSOR aI<tY60� ,
Kk.:, T• :f7f Wtir 5A7IQ•
Phone (860)528-5252
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Applicant agreed to h they
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required and to reJJTVUr efr q Ito`. :��r6� �i � auy �e�Inses
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incurred by the TowA. ft'f' k-OU an ce or repair wore}�10 n y_ tion with this
permit and that a 1`£cnE ' ' ait �'m'� e rules and
regulations for permi` s a ofaBP;ine y r t I'�Qf Sp ti `ht.W_ i dwor's Street
Cut Permit Manual. ,a?.
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* * PERMIT TO`` .E ICvvPl' OAf`t�CIB: � E' 2TI[ ES.
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_Date Completed -- Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
(' FEE $25.00
Name of Firm c� �j(�-jL�
Address of Firm Phone No.
Location of proposed work 3
Describe fully nature of permit•requested
Starting date_ ECG i<i 6
Call Before You Dig No. Approx. time for completion
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section.to be filled out b
Town of South Windsor
Pavement Cut
No.cuts
Est.Size of Perm.Patch(s)
Est.Pvt.Thickness _in.
Est.Unit Price
Amt.of Deposit
Total Due$ f) by
Cash( )Check#
/ S Permanent Patch _
V No. Cuts
Size of Patch(s)
�xtST
Final Billing
Amt.Due Payee
Amt.Due Town
By
Applicant is responsible for contacting
the Police De t.and C.B.Y.D. Dat
I AGR 0 FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
TOW OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WOR THE
K IN
CON ECT N WITH THI ERMIT AND THAT I AM FAMILIAR WITH AND WILL ASIDE BY THE RULES AND REGULATIONS FOR
PER ITS S TLfN IN THE T N OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
Date:_
Title:_
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
TOWN OFSOUTH WINDSOR
ENGINEERING DEPARTMENT
ADDRESS PERMIT NO. SHEET
OF
UTILITIES INSPECTOR TEMP.PATCH DATE
INSPECTOR COMPLE77O-DATE
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