HomeMy WebLinkAboutdriveway Street Cut Permit 61 Carson Way 1000094 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/26/10
GIS ID: 17600061 FEE: 25.00
MUNIS APPLICATION# 201000631 EXPIRATION DATE: 05/26/11
APPLICANT LOCATION
NAME: M&S PAVING AND SEALING,R ADDRESS: 61'CARSON WAY
ADDRESS: 435 BUCKLAND ROAD OWiVER: TALI ULIS,JOHN&VICTORIA
SOUTH WINDSOR,CT 06074 61 CARBON WAY
SOUTH WINDSOR,CT 06074
PHONE 860-648-1915
WORK DESCRIPTION: DRIVi"
APPLICANT AGREES TO FURNISH THE TOWN OF'S'OUTH WINDSO.R THE`AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED B'i'THE:TOWT FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT S'RAMIIAl t ITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH W SR'. 'STREET CUT PERMIT MANUAL.
ISSUED BY KATEINSPECTED INSPECTED BY
5/26/20102:04PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 0000 CONTRACTOR: q-
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 3 -3
INSPECTED BY:—..Go
WORK IN
PROGRESS: �.�,d ;Ue�x, 04
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: i' DATE: 3 1
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT 0000 g y
TOWN OF SOUTH WINDSOR Permit'.No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm YY1 G P Y'Ot Phone No. 00— t0 9 9 f 3
Address of Firm I"I i ac'o- l,J
Location of pro sed work
(01 W -
Describe fully nature of permit reque ed S
Starting date Approx.time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or famish
two copies of separate drawing Indicate North This se on to be filled out by
Town of South Windsor
Pavement Cut
— — No:cuts0 _
Est.Size of Perm.Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit
Total Due$ by
( ),Cash( }Check#
Permanent Patch
a3 No. Cuts
Size of'Patch(s)
Final Billing
1
Amt.Due Payee
Amt,Due Town
By
Applicant is responsible for contacting Date
the Police De t.and C.B.Y.D,
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN OF SOUTH WINDSOR 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:-.�1 l' 1
Tide: l C Driver's License#:
PERMIT H LL BE KEPT ON JOBSITE AT ALL TIMES