HomeMy WebLinkAboutStreet Cut Permit 50 Deepwood Drive 1000207 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/28/10 '=--
GIS ID:27000050 FEE: 25.00
MUNIS APPLICATION# 201001321PIRATION DATE: 09/28/11
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APPLICAN - �'���_= � � s LOCATION
NAME: BOUTIN&SONS 5 % RE0 DEEWOOD DRIVE
ADDRESS: 121 WINDSORVILL - IAIU ROBERT E&ANNE M
BROAD BROOK CTIlb6 6 - d0 D P`�,V,,O,�,O- D DRIVE
, �� %� `�J VX11v1JSOR,CT 06074
PHONE 860-623-2526
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WORK DESCRIPTION: DRIP
APPLICANT AGREES TO FURNISH THE IQ 1 (IIJTHs �/AM� f ( ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANN,SFIVCTHR $�WI�JOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI �P14
AAM IARH AL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O ft'PIT MANUAL.
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ISSUED BY DATE INSPECTED INSPECTED BY
9/28/20109:29AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1 cooa o -7 CONTRACTOR:— #+yj
LOCATION: 5 0
TYPE OF WORK: c`\v-e L-3a
DATE INSP NEEDED: DATE INSP: 2S !r
INSPECTED BY: 80
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: OA DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
OWN OF SOUTH WINDSOR
PUBLIC- WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN.AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Boutin & Sons Const. Co. Phone No. 623=2526
Address of Firm 121 Windsorville Road roa rook, Conn
Location of proposed work 5l7 ;L1eepwood 1 1-ya
Describe fully nature of permit requested - Strip existing driveway, dress with process gravel ,
grade, roll and pave.
Starting date Approx.time for completion
Call before you dig no. .201039017 74 Traffic Services Control No.
Show sketch of proposed work or furnish TO be Filled out by Town of So. Windsor
two copies of separate drawing Pavement Cut
Indicate North / Prop.size of cut
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No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm. Patch
No.Cuts
Final Billing$
Amt. Due Payee $
Amt.Due Town$
Applicant is responsi le 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 JOSSITE AT ALL TIMES