HomeMy WebLinkAboutStreet Cut Permit 121 Woodland Drive 1000208 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/28/10iaon
GIS ID: 96900121 FEE:
MUNIS APPLICATION# 201001324 � 25.00
s� y r ;�IRATION DATE: 09/28/11
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APPLICAN —mom ' ' LOCATION
NAME: BOUTIN&SONS
ADDRESS: 121 WINDSORVILLF32XA�I41- X- % �`�f �=l IW- b- DRIVE
BROAD BROOK,CT606 = ' ZD TRUCE L&JANIS
r - -06DLAND DRIVE
5 ` VINDSOR,CT 06074
PHONE 860-623-2526 =sy,= �
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WORK DESCRIPTION: ' � AZZ
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APPLICANT AGREES TO FURNISH THE T �F 3
THE TOWN OF SOUTH WINDSOR FOR ANI ,AM T( ND REQUIRED AND TO REIMBURSE
ISE1fCU dTFfQINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH �P A A1V S AR" i A�VL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF Ll _ Ig`PMp�IT MANUAL.
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ISSUED BY DATE INSPECTED INSPECTED BY
9/28/20109:54AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1000a O 9) CONTRACTOR: 0
LOCATION: 1,11 t,)oDcd Carol Jai
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 11
INSPECTED BY: db
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:- DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC• WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN.AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Boutin & Sons Const. Co. Phone No. 623=2526
Address of Firm 121 Windsorville Road roa rook, Conn
Location of proposed work 121 Woodland Drive
Describe fully nature of permit requested Strip existing driveway dig out lawn area , add
process gravel, grade, roll and nave.
Starting date Approx.time for completion
Call before you dig no. 20103901685 Traffic Services Control No.
Show sketch o propo vworKor furnish j . To be fined out by Town of So. 'Windsor
two copies of eparate drawin 1 !L — Pavement Cut
7 . . �
Indicate N rth I ` . Prop.size of cut
,3 t No.cuts
l}' I Amt.of Deposit S by
i IG f O Cash O Check#
` •� v 11 , Cut size after Perm. Patch
b No.Cuts
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Final Billing S '
�- Amt.Due Payee S
D 1 Amt.Due Town .$
Applicant is respon ble for contacting v a�
the Police Dept. a C.B.Y.D• by • date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF
SOUTH WJNDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS
PERMIT AND THAT 1 AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed; Date.•
Title: L7 C� / D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES