HomeMy WebLinkAboutStreet Cut Permit 55 Niederwerfer Road 1000183 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/10/10
GIS ID: 63600055 � ,� y y FEE: 25.00
MUNIS APPLICATION# 201001198
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IRATION DATE: 09/10/11
APPLICAN � � � W—��
LOCATION
NAME: M&S PAVING AND S A ,1N - � SNIEDRWERFER ROAD
ADDRESS: 435 BUCKLAND RO E g - €►IiTbN RICHARD L&LINDA A
SOUTH WINDSOR,G� 66 _ T *WERFER RD
� 7 VINDSOR,CT 06074
PHONE 860-648-1915 A �=
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WORK DESCRIPTION: DRIVE 01F �� - y
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APPLICANT AGREES TO FURNISH THE N&TH}IWO— AM4 Cf"BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A QV S INCUwal ®i AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THEAN IA� I AL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN-OF JT SR � E `cif P IT MANUAL.
ISSUED BY DATE INSP CTED INSPECTED BY
9/10/201011:52AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: / 060163 CONTRACTOR: In a- j cr V ll?
LOCATION: ^� da�T4�9 V 4
TYPE OF WORK: DY 1 V`e oa J
DATE INSP NEEDED: DATE INSP: i 3
INSPECTED BY: B D
WORK IN
PROGRESS: L ma k S oK
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: Is '
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT /000/16,3
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR-,CT 060t4
FEE $25.00 [/�i c
Name of Firm ` S l t N A-un Phone No. T6 "
Address of Firm
Location of proposed work
Describe fully nature of permit request t 11 12
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Starting date �1U Approx.time for completion_ V _
Call Before You Dig No. �(,� Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North 0Town of South 41+lnctsor
Pavement Cut
No.cuts
Est.Size of Penn.Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit
Total Due$ by
{ )Cash( )Check#
Permanent Patch
No. Cuts
- Size ofPatch(s)
Final Billing
Amt.Due Payee
Amt.Due Town
By
Applicant Is responsible for contacting Date
the Police De et.and C.B.Y.D,
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 OUTLI IN HE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: c�' I�Date:
Title: Driver's License#:
PERMIT HALL BE KEPT ON JOBSITE AT ALL TIMES
o r
435 Buckland Road 6 Springside Avenue
So. Windsor, CT 06074 Danbury, CT 06810
Ph: (860) 648-1915 Ph: (203) 790-9727
Fax: (860) 648-4602 P&WO UMO Fax: (203) 794-9172
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