HomeMy WebLinkAboutDriveway street Cut Permit 118 Palmer Dr 1000045 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
N s-
DATE: 04/05/10
GIS ID:68400118 FEE: 25.00
MUNIS APPLICATION# 201000322 RATION DATE: 04/05/11
APPLICANT _ LOCATION
NAME: BOUTIN&SONS ER DRIVE
ADDRESS: 121 WINDSORVILL s E ANROBERT
BROAD BROOK,CT OW ER DRIVE
INDSOR,CT 06074
PHONE 860-623-2526 ice.
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WORK DESCRIPTION: DRIV AY
APPLICANT AGREES TO FURNISH THE T OND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE S LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN l THE TOWN OF SO Vl S1 RMIT MANUAL.
'
ISSUE Y DATE INSPECTED INSPECTED BY
4/5/201010:29AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /0619y 1S' CONTRACTOR: LlP u
LOCATION: JI TG j �2 1�ri v�-e_
TYPE OF WORK 'Del �yfalz y
DATE INSP NEEDED: DATE INSP: I la5yo
INSPECTED BY: �
WORK IN
PROGRESS: .. viS l/� [21�
SEPTIC TANK PUMPED, SMASHED,FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
W12007 Town of South Windsor INPSEMON REPORT 07
�0 10 0 v 3Z,2 /c� S
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN. AVENUE
SOUTH WI DSOR, CT
FEE $25.00
Name of Firm Boutin & Sons Cons t. Co. Phone No. 623-2526
Address of Firm 121 14indsorvi e Roa roa rook, Conn
Location of proposed work `
Describe fully nature of permit requested
Starting date / 0 Approx.time for completion
Call before you dig no. Traffic Services Control No. _
Show sketch of proposed work or furnish TO be filled out by Town of So. Windsor• two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
()Cash dCheck#_3 I .
Cut size after Perm. Patch
No.Cuts
Final Billing$
Amt.Due Payee S
Amt.Due Town S
Applicant is responsible for contacting by__.—_ date—
the Police Dept.and C.B.Y.D.
1 AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSO'R THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF
NANCE OR REPAIR WORK IN CONNECTION WITH THIS
SOUTH WJNDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTE
PERMIT AND THAT 1 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.
Date: —
Signed
jazz
D.L.#
Title:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES