HomeMy WebLinkAboutStreet Cut Permit 38 Ident Road f
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3879 Cc acto ��COVEx�STRUCTION CO.
Location 0038 IDENT ROAD ;idw a i;P.0&,gB °'4 7%w.;k
Type Work STORM u,. .w ! VSN
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Date Insp Needed y'
Time Insp Needed
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Work in Progress
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Permit No. 3879 Town of South Windsor, CT
Date 11/01/2004 " '"""`w,:.
ten""' Street Excavation Permit
Expiration Date 11/01/2005 s �� ` • ;
Descrip:
Applicant
Name COVEN CONSTRUCT ON CO', a•
ENT
.. `... .,,
Addr. P.O. BOX 427 �.
COVENTRY CT 0638»" s
Phone (860)282-0526
Applicant agrees th e.• `
".'.' :• i Win car t iE ,&blunt of bond
required and to rei' �� ;gnUurs�*:'<'{g o" r a. Y`° pnses
xs -? 'ham, :6
incurred by the Town t t' ance o re airywo
�� P. anti on with this
permit and that a lk nt 's. a i as w :T'i. :i" e,b �e rules and
egulations for perm t.s :. Y ,
3.n
lfzfh! iaicsor s Street
Cut Permit Manual.
* * PERMIT TO� E`!I�F OI`�$ `AF -T'TI}ES.
Issued by —----- --V V`— s. i t 1 e ---------------
Date Completed Inspected B
1Arf-L1t,/k I wN t-UK STREET EXCAVATION PERMIT ;3=
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No. .
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
E $25.00
Name of Firm rN )A C Phone No.
Address of Firm k c ----��
Location of proposed work
Describe fully nature of permit requested G,
Starting date
Approx. time for completion_
Call Before You Dig oX3 �/, (� t'?(�O J 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 is
Est..Size of Perm.Patch(s)
Est.Pvt.Thickness _in.
Est.Unit Price
Amt.of Deposit
Total Due by
( )Cash;( )Check#
I°q -Permanent Patch .
No. Cuts
Size of Patch(s)
• Final Billing .
Amt.Due Payee
Amt.Due Town
By
Applicant is responsible for contacting
the PoXUH
B.Y.D. Date
AGRTO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWNDSOR FOR ANY'EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONN S PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMIN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed Date: v
Title:
Driver's Lic nse#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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