HomeMy WebLinkAboutStreet Cut Permit 369 Troy Road 1000135 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 07/28/10 _ P
GIS ID: 90000369 -° FEE:
MUNIS APPLICATION# 201000949 25.00
RATION DATE: 07/28/11
APPLICAN AK LOCATION
NAME: BOUTIN&SONS s S R ROAD
ADDRESS: 121 WINDSORVILL3
LLIAM N&ATHENA TRUSTEES
BROAD BROOK,CT= 6 ROAD
PHONE 860-623-2526 £
Off£ SOR,CT 06074
WORK DESCRIPTION: DRIV
APPLICANT AGREES TO FURNISH THE T O E ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY G AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE `T ND . LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S UT IT MANUAL.
ISSUED DATE INSPECTED INSPECTED BY
7/28/201012:45PM ' PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 106013.5� CONTRACTOR:_
LOCATION 3 9
TYPE OF WORK: �(
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: !M
WORK IN
PROGRESS:�.�
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: , DATE:
W/2007 Town of South wndsor INPSEMON REPORT 07
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 Cons t. Co. Phone No. 623=2526
Address of Firm 121 Windsorville-Road Br3aci. brook, Conn OSM
Location of proposed work 369 Troy Road
Describe fully nature of permit requested Strip _eXisting driveway, Tess with process
gravel, grade, roll and pave.
Starting date Approx.time for completion
Call before you dig no. 20103000616 Traffic Senrices Control No.
Show sketch of proposed work or furnish TO be filled out by Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
. No.cuts
Amt.of Deposit S by
Cash O Check#
Cut size after Perm. Patch
No.Cuts
Final Billing S '
Amt. Due Payee S
Amt.Due Town S
Applicant is responsible for contacting
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 I 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.• /20/10
Title: Secretary D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Job Location:
i Description:
LL
CAAIF
1,31 -
Ouote Good for 6 ays.
Special Attention: 1/2 Payment Upon Starting, lance Upon Completion. v u
Contract
--- — Permit-1 A4, �C)
ONE YEAR GUARANTEE ON WORKMANSHIP&MATERIALS.
% Pres.
CSUD ' '7
S r, Date