HomeMy WebLinkAboutStreet Cut Permit 146 Pine Knob Drive 1000200 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
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DATE: 09/21/10 y
GIS ID:72000146 -"r
FEE: 25.00
MUNIS APPLICATION# 201001267 9 `� � �y �MIRATION DATE: 09/21/11
APPLICAN - - " % ;% LOCATION
NAME: BOUTIN&SONS - - y s
f 1 }6 PINS KNOB DRIVE
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ADDRESS: 121 WINDSORVILLQ -I B ALBERT J
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BROAD BROOK,CT6 y sy � #6 1UNII DRIVE
q, SOR,CT 06074
PHONE 860-623-2526 y �
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WORK DESCRIPTION: DRI &i y
APPLICANT AGREES TO FURNISH THE'?OM-f DI�� ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A0XETtCLTHR0 :41AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE AI�PL1� IAf� f 4f L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF UT I TDS)f�SEMIICUT REP�I v1IT MANUAL.
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ISSUED BY DATE INS ECTED INSPECTED BY
9/21/201011:23AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: Qona oo CONTRACTOR: L6(J
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: .�
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: c DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FORSTREET EXCAVATION PERMIT
N 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 Windsorvi e Roadroa rook, Conn
Location of proposed work 146 Ping Knob Drive
Describe fully nature of permit requested complete dig Out of driveway, add V=cess grail,
grade, roll and pave.
Starting date Approx.time for completion
Call before you dig no. 20103800433 Traffic Services Control No.
Show sketch of proposed work or furnish TO be filled out bV Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate Nor Prop.size of cut
No.cuts
Amt.of Deposit S by
1_ O Cash O Check#
1Y I Cut size after Perm. Patch
No.Cuts
Final Billing S '
Amt. Due Payee S
/ Amt.Due Town S
Applicant is resp sole for contacting a�
the Police Dept. nd C.S.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:�:!�;d 9/13/10
Title: Secretary D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES