HomeMy WebLinkAboutStreet Cut Permit 16 Fairview Drive 1000171 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/19/10 3
le
GIS ID: 31500016 FEE: 25.00
MUNIS APPLICATION# 201001088 �� 'IRATION DATE: 08/19/11
APPLICAN LOCATION
NAME: BOUTIN&SONS " ?- ARE� u 1l AIR IEW DRIVE
ADDRESS: 121 WINDSORVILL g sRD STEPHEN P&
BROAD BROOK,CT €6 � g1IR EW DRIVE
T� SOR CT 06074
PHONE 860-623-2526 ,
WORK DESCRIPTION: DRI
APPLICANT AGREES TO FURNISH THE N61jTEj AM ( BAND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A - 91
C MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH I1 L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OFI ,, F`1` 1'p IT MANUAL
a�
ISSUED BY DATE INSPECTED INSPECTED BY
8/19/20109:28AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
.................-- ......... ----------- --............. ------------------------...._----............ ....... ---------------------------------------...... ............---..... -------------------- .......--............... .............-------------------------..-----------------------
�� �
m
� -
y
' �- �g
' -------------
a w }
Ap
ye ef
y
�� 14W �y �
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: OW 7, CONTRACTOR: &utj /U
LOCATION: (Z'V I e L.J
TYPE OF WORK: 1�' U�at t,P
DATE INSP NEEDED: DATE INSP:4
INSPECTED BY: Bb
WORK IN
PROGRESS: a'VIAr
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C.qNf\ DATE: - J
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT '
OWN 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 06016
Location of proposed work_-a�G t,,..a�....eri.@ Drive
Describe fully nature of permit requested Strip . existing dr ivewaY, -Ld s' with process—gr- ve 1
grade, roll and pave.
Starting date Approx.time for completion
Call before you dig no. 20103400091 Traffic Services Control No.
Show sketch of proposed work or furnish TO be filled out by Town of So. Windsor'
two copies of separ to drawing Pavement Cut
Indicate rth Prop.size of cut
No.cuts
Amt.of Deposit S by
5 !' ! O Cash O Check#
Cut size after Perm. Patch
No.Cuts
3 1 Final Billing $ '
�� cr�T-G IJ1,�/G Amt. Due Payee $
��1 `
r"� � Amt.Due Town$
Applicant is fesponsibie for c t ctingL 011
the Police Dept.and 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: 8/16/10
Secretary `
Title: D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES