HomeMy WebLinkAboutStreet Cut Permit 498 Buckland Road 1
Permit No. 4291 Town of South Windsor, CT
Date 09/14/2006 ,.,;-<°«" " «mom Street Excavation Permit
Expiration Date 09/14/2007
Descrip: WATER SERVICE CUT
Applicant ;,
Name J & H SLATER CONST CO
Addr. 75 COMMERCE WAY „as.
SOUTH WINDSOR CT -Q � � l";
Phone (860)528-5252
Applicant agreed Co""fri3, rtherr7:.;:ss ;} Winclq ":rtTe alto>int of bond
required and to i .' `° "'µz:
reiWOU-- S -� "P 6%.: r X,a Prises
incurred b the Tow c ?' : ,
Y 11 ;. ik :�t.�anc`( E" r" L i'a � ft }^: Tn ction with this
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permit and that appl 'cY1' i '_ gs3m =r $ ° brey "t1 e rules and
n
regulations for permi'.s ag. oyx't ;in 't3" S ttif:Tzj ' 59th 1 nd5`'or's Street
Cut Permit Manual.
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* * PERMIT TO�"BE
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Issued by
Date Comple)ed _+_—_----_- Inspected By
V
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4291 Con..tx, :&btor AJ & H S`t>AT,. R CONST CO
Location 0498 BUCKLAND ROADei sj Is:75 iwII 3yRC P7 Y
WATER
Type Work :r' w>qt
....... - ?: kJ .,W3N&''jOR CP=.:,06074
Phone:No..'(::8; Ar: -52=9=5`2:52
Date Insp Needed £..a t �i
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Time Insp Needed
Inspected B } a :" ,>.r• ;:.ar?" '
Work y' y 4i
in Progress
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APPLICATION FOR STREET EXCAVATION. PERMIT 01 q/
TOWN OF SOUTH WINDSOR Permit PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE- -
SOUTH WINDSOR,,CT 06074
FEE $25,00
Name of Firm `
Address of Firm C,6 L Phone No._ z s -- -�,
Location of proposed work u
Describe fully nature of permit requested
Starting date
Call Before You Dig No. (0 ( ?7 Approx.time for completion
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South�Windsor
Pavement Cut
No.cuts r
Est.Size of Perm.Patch(s)
ec' AA Est Pvt.Thickness- T in.
Est.Unit Price$
Amt.of Deposit
Total Due$ by
Cash( )Check# -
/' Permanent Patch
No. Cuts
Y r�.
Size of Patch(s)
�o OL
Final Billing
Amt.Due Payee
Amt.Due Town
B
Applicant is responsible for cn tin y
Dthe Police Dent and(I ra at e
1 AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN OF UTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNEC ON ITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMIT. AS U LINED E TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: f p�
Date:_
Title:
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
TOWN OF SOUTH WINDSOR
ENGINEERING DEPARTMENT
ADDRESS
PERMIT N0. SHEET
UTILTRES Of
INSPECTOR TEMP.PATCH DATE
INSPECTOR COMPLETION DATE
1
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