HomeMy WebLinkAboutStreet Cut Permit 80 Fairview Drive 1000162 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/12/10
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GIS ID:31500080 � FEE:
MUNIS APPLICATION# 201001043 25.00
= RATION DATE: 08/12/11
25.00
APPLICA
NAME: M&S PAVING ANDS ;+ LOCATION
O. &�FAIR' EW DRIVE
ADDRESS: 435 BUCKLAND RO : tip 3 INDA C
SOUTH WINDSOR,
z. I FM IEW DRIVE
PHONE 860-648-1915 3
INDSOR,CT 06074
WORK DESCRIPTION: DRIV
APPLICANT AGREES TO FURNISH THE T Ti - F ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY II
CONNECTION WITH THIS PERMIT AND THE _ AINTENANCE OR REPAIR WORK IN
L THE RULES AND REGULATIONS
- ABIDE B Y
FOR PERMITS AS OUTLINED IN THE TOWN OF S T I1 It�AIJ
ISSUED BY DATE INSPECTED INSPECTED BY
8/12/201012:02PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
---------- -......-...."--------- -.... - ....__.....__................-..............._... ... -----.......................
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
or
PERMIT NO.: go 0'2 CONTRACTOR:
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LOCATION: go.. r-a j (z.U I ' D r I
TYPE OF WORK: �D c I \I(f oar
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 3D
WORK IN
PROGRESS: a& C,J 1vo't 01
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: COA- DATE: �-
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
z TOWN OR SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN•AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
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(Yl PAr I n c c n ll phone No. io( - ��-1-IQQ
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Name of Firm
Address of FirmLela
Location of proposed work f Z
Describe fully nature of permit requested .2 lc.Ut i✓
" -
Starting date 11 Approx.time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish This section e filled out by
to b b
two copies of separate drawing Indicate North Town ion to h Wlndsor
0 Pavement Cut
No:cuts
Est.Size of Perm.Patch(s)
Est.Pvt.Thickness In.
Est.Unit Price
Amt.of Deposit
Total Due$ by
.( )C.ash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
, S
Amt.Due Town
By _
Applicant is responsible for contacting Date
the Police Dept,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 OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. -
Signed: Date,—
Title: Driver's License#.
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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 Q 0 �° Fax: (203) 794-9172
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Toll Free: 1-800-486-S-EAL - www.mspave.com Email: sales@mspave.com