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HomeMy WebLinkAboutStreet Cut Permit 132 Pine Knob Drive 1000105 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER STREET CUT PERMIT DATE: 06/22/10 _' y GIS ID: 72000132 FEE: 25.00 MUNIS APPLICATION# 201000758 ,��V --dt?IRATION DATE: 06/22/11 s /i . APPLICANT LOCATION NAME: PAGANI CONSTRUC'I .0 913 REW PINT KNOB DRIVE ADDRESS: 15 KING STREET VQTE DAVID E&CATHERINE R VERNON ROCKVILI T 36 Z' PINI KNOB DRIVE PHONE �U DSOR,CT 06074 y ��i� /! y y WORK DESCRIPTION: DRIAlaY APPLICANT AGREES TO FURNISH THE TCV� FJTH / THE TOWN OF SOUTH WINDSOR FOR ANY% tM�3fiT� $ ND REQUIRED AND TO REIMBURSE PiCi�1 ��H1 _ O1tGIAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND THE 1 'LAIF1 � A L ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SRO JT INDSR TI£Jf CU"PP IT MANUAL. ISSUED BY DATE INSPECTED INSPECTED BY 6/22/201010:45AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** ��w w i i y AN i i y wi- WOW AF , i 13 0 W ir i' �j�� I j % i" ` _ TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: CONTRACTOR: CQ a-n LOCATION: -/3 a eh� �l ) TYPE OF WORK: b f 1 DATE INSP NEEDED: DATE INSP:_ t INSPECTED BY: Q2D WORK IN PROGRESS: _ �o dvV-s b�C SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED (l YES ❑ NO AS-BUILT: INPUT: C DATE: W12007 Town of South Windsor INPSECTION REPORT07 APPLICATION FOR STREET EXCAVATION PERMITS©����� TOWN OF SOUTH WINDSOR Permit No. PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00 Name of Firm P, Phone No. Address of Firm so— Location of proposed work V-3o j Describe fully nature of permit requested Starting date o ori�ee.- Zc>\ zo Approx. time for completion Call Before You Dig No, Traffic Services Control No. A3 f A 'Show sketch of proposed work or furnish This section to be filled out by two copies of separate drawing Indicate North Town of South Windsor Pavement Cut No.cuts Est.Size of Perm. Patch(s) Est. Pvt.Thickness in. Est. Unit Price$ i Amt.of Deposit$ p� Total Due$ by H ( )Cash( )Check# v Permanent Patch No. Cuts L`L� t�jd3 y Size of Patch(s) S1 inal Billing Amt. Due Payee 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 TOW OUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN C NECTIO ITH TH RMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PtRMITS AS O LINE IN E TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. Signed: &AysJ Date: I PZQ-Ne- Title: Driver's License#: 1 —x PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES ;� 1 G�Z, � t"