HomeMy WebLinkAboutStreet Cut public utility 140 Kent Lane 1000236 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 11/29/10 s �
GIS ID: 50100140 FEE: 25.00
MUNIS APPLICATION# 201001599 � _ " EVIRATION DATE: 11/29/11
APPLICAN - _ = y�� -- LOCATION
NAME: BOUTIN&SONS /� a� ?RE�� 140 Kbt LANE
ADDRESS: 121 WINDSORVILLEAQ& SCOTT&CINDY
BROAD BROOK,CT h60=16 - T40 KEG'LANE
` 01J`W V INDSOR,CT 06074
ah
PHONE 860-623-2526
WORK DESCRIPTION: DRIV � y
no ,
�i
APPLICANT AGREES TO FURNISH THE TO F"SOUTH a��� a AM�UI�T OR BAND REQUIRED AND TO REIMBURSE
FOR
THE TOWN OF SOUTH WINDSOR ANINFfVCTITDWIajA IGIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE Ap1'LARflAN IAI AVL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SQIfTT WIDSRfS13E1rIIPIIT MANUAL.
'=
ISSUED BY DATE INSPECTED INSPECTED BY
11/29/20102:36PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
- -- .. ---- ------ - --- - -------- -- ...... - - ........ - - --------...................................
s y%
gr?�� ,
� /
%�� „
%�� y
j
y is s
s
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I Q00 a3 6 CONTRACTOR: 2
LOCATION: / yo &nt LA)
TYPE OF WORK: of .r),-
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: 3r
OiL
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: a 3
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 Windsorvi a Roadroa . rook, Conn
06016
Location of proposed work 140 Kant T anA
Describe fully nature of permit requested Strip gp nn,_9ra(j'0 Bnd rnl 1 apd _ �nVe
Starting date 11/2 4 10 Approx.time for completion 1-
Call before you dig no. 901 04]02461 Traffic Services 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
�J� (}Cash(JCheck#
/� IL
l b Cut size after Perm. Patch
IN > No.Cuts
,QnGre le
Final Billing 8 '
Amt.Due Payee S
Amt.Due Town 8
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:
Title: D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
1