HomeMy WebLinkAboutStreet Cut Permit 20 Autumn Drive 1000106
PERMIT NUMBER TOWN OF SOUTH W I N D S O R, CT
STREET CUT PUBLIC UTILITY
DATE: 06/22/10
GIS ID:06000020
MUNIS APPLICATION# 201000759 FEE:
EXPIRATION DATE: 00
APPLICANT'
NAME: PAGANI CONSTRUCTIQN,LLC LOC-- ATION
ADDRESS: 15 KING STREET ADDRESS 20.AUTLhMN DRIVE
VERNON ROCKVILLE,CT 06066 OWNER: HAFFNER J SCOTT&DEBORAH T
20 AUTUMN DRIVE
PHONE SOUTH WINDSOR,CT 06074
WORK DESCRIPTION: REPLACE BROKEN FIRE HYDRANT
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH
WINDSOR THE.AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INC CONNECTION WITH THIS PERMIT AND THE AP'PLICANT'IS FAMID H BY,THE A ALL ABIDE BY THE RULES AND REG
WN FOR MAINTENANCE OR REPAIR WORK IN
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSR'S STREET CUT PERMIT MANUAL.
ngo ULATIONS
/Io
ISSUED BY �4� INSPECTED BY
6/22/201011:09AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN.OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION: ® jj f t.:kL 4 M
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: �n C
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED YES ❑ NO
AS-BUILT:
INPUT: DATE:
w12007 Town of South Windsor INPSECTION REPORT 07
12/14/ZU(Jb TUE 8:33 YAX 850'644 7280 South Wl)adsor Town Hall Lim 002/002
APPLICATION FOR STREET EXCAVATION.PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $26.00
-Name of Firm
Phone No. if6o-6 Z's-3 3Cs�
Address of Fi
Location Of PrDPosed work
Describe fWly'nature of permit requ
Staffing date 6 Ze ed Approx.time for compietio
Call Before You Dig No.
Traffic Services Control Na.
Show sketch of proposed work ar furnish
two copies of separate dravAna Indicate Norm Sftsgon to be
Town pf South Windso
Pavement CUt
No,cuts
Est'Size of Perm,Patch(s)
----------
Est Pvt Tmdmes$ in.
L-st Unit Price
Aint of Deposit
Total Due
cash ChU*#
Permanent FWcfi
No. Cuts
Size of Patch(s),
Final Billing
Amt.Due Payee
Amt.OLIeTown
st by
Applicant:is re-sponsible for contaoting
the Police Dept.and C.B.y.U_
I AGREE To FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF
TOWN OF SOUTH WINDSOR FOR ANY EXpENSES .BOND.REQUIRED AND To REIMBURSE THE
CONN ECTION-WrM THIS PERMIT AND THAT I AM FA ILI
INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
PERMI.TS M AR WITH AND WILL ABIDE IDY THE RULES AND REGULATIONS FOP.
S 0 INED 1*7_fJE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL-
Signed
Date! X
Driver's License
PERMIT SHALL BE KEPT ON JOBSITE AT ALL,TIMES
6 'd N09 "N U012;� U"WON "14 13 WSl :6 E06 '66 'Inr