HomeMy WebLinkAboutStreet Cut Permit 62109999 Nancy Drive TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4294 Contzaoc *br`VMS`C'bNS:�jZUCTION COMPANY
Location NANCY DRIVE BETWEEN DAWN DR. �Ac�dres `d Kh62.7a 1KE<:.STREET
Type Work STORM ' ` S:E�tNON"CT,:rp6Q66?;
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Permit No. 4294 Town of South Windsor, CT
Date 09/21/2006 Street Excavation Permit
Expiration Date 09/21/2007
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Descrip: REPLACE- STORM DRAINAQE'�
Applicant
Name VMS CONSTRUCTION vOI 'NYf kF � 'IizB}ENFEEN ISAN DR.
Addr. 162 LAKE STREET '`3
VERNON CT 06066 Wo
Phone (860) :: = �y.:•..'k '` °'
Applicant agree to-rftr " heyT;4:Xari ,; .'.<> �uh WirtsE;Cie at4tount of bond
required and to rembu' s :. own o :9.. ' li.. sor f`{�r.ari. ;ex eases
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<^Ya 4t Xv.. <;CtiY .'`. �: 'O.:S:cY
incurred by the Tow f3 g#a en"r r b„ k ry stan iec if with this
permit and that appir -�tmi rules and
F It: 2 3 tit-thX Win'dsdr s Street
regulations for -permt as°"i� : .1e1 : :.'' •<'
Cut Permit Manual. Q ;..n {, ;;;..:.•.,;
* * .PERMIT `2A B 'I(SPP 09
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A P TZMjr
Issued by
Date Completed ------------ � : ;. x -P trt ecl By ----
APPLICATION FOR STREET EXCAVATION PERMIT . 41z�
TOWN OF SOUTH WINDSOR Permit N
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm_ i��s C•as-TjZ�. C-0 Phone No. ��6 0 -ZI�f- 77.
Address of Firm ��? ( �.� � f
Location of proposed work_ N ►c j p f?
Describe fully nature of permit requested ZL/ y 2 X ,j
30" 2�f
Starting date � 2 ,G
Approx. time for completion_
Call Before You Dig No. Z'n, 6 3 F0 Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South�Windsor
Pavement Cut
I/ No.cuts
((( Est.Size of Perm.Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$
-�o 13 F Soh RJ ®�9� Amt.of Deposit$
�� Total Due$
by
( )Cash( )Check# .
Permanent Patch
No. Cuts
Size of Patch(s)
DAL.).' -ok
Final Billing
Amt.Due Payee
$
I o G•j'�ei r�� $Amt.Due Town
By
Applicant is responsible for contacting
the Police De t.and C.B.Y.D. Datp
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN OF SOUTH WINDSOR 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 UT INED IN THE TOWNOF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: l Date: ZZ
Title: P2�s/D� -�
Driver's License M GT /`7 y 2 0 2 L yr/
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES