HomeMy WebLinkAboutStreet Cut Permits 38 Carson Way (2) 1100161 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/11/11 =-
GIS ID: 17600038 FEE: 25.00
MUNIS APPLICATION# 201101185 EXPIRATION DATE: 10/10/12
APPLICANT - LOCATION
NAME: M&S PAVING AND SBALINd,INC = ADDRESS. 3S CARSON WAY
ADDRESS: 111 COMMERCE WAY = OWNER: KEISE COLLETTE M
SOUTH WINDSOR,CT06074, 38 CARSON WAY
SOUTH WINDSOR,CT 06074
PHONE 860-648-1915 -
WORK DESCRIPTION: DRIA�WAY
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH W1NI)$pi iFIE AMOUNT QF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH API'LICANT-IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WI1]DSR' STREET CUT,PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
10/11/201110:21AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: rO
LOCATION:_ 3 9 ca 2 s6n W k
lYPE OF WORK:_ ��',\�P UJa c�
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:__
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
'AS-BUILT:
INPUT: CIS DATE:
W/2007 Town of South Windsor INPSECnON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT /! D0b�
TOWN=00 SOUTH VtitfNbSOR Permit No.
PUBLtC WORK$pEPARTIVfINl
'6011-HALL
1640 SUhLIVANAVENU
SOUTH Wilk-
-USR,CT 66074
FEE
rib
Name of Firm M S P w�.�� �� Q ems` Phone No.— L�O- (o y 8-
Address of Firm CA � ��c,,� vx'c`� S •,.,�• _
Location of proposed work_ 3 c?) Got -s v•-.� ..�
Describe fully nature of permit requestet!
Starting date Approx.time for completlon cod +'Jar�S
Call Before You Dig No.`�_ 6 Traffic Services Control No.
Show sketch of proposed work or furnish This section to.be:fiiled out by
two copies of separate drawing Indicate North Tovvq ofiSouth Windsor
Pavement Cut
No.cuts
Est.Size of Perm_Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price
Amt.of Deposit
7aSafDue$ by
`}.Gash( )Check#
Permanent Patch
No. cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
Amt.Due Town
B
Applicant is responsible for contacting Dete
the Police DgRt.and C.B.Y.D.
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THIS AMOUNT QF Bs I�f7 REC UtftED AND TO REIMBURSE THE
TOWN OF SOUTH WINDSOR FOR ANY EXPENSES iNCURAED B THE,TOWN FS R I+ INTENANGE OR.REPAIR,Wt)R1E IN
CONNECTION WITH•THIS PERMIT AND THAT-I AM FAMILIAR WITH 4ND 1IU)l:l l 11 B BY TF EA-LES AN6 9tGULATiONS FOR
PFRMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR`S SfR _r"GUT pe l UAL.
Signed: Date 9 �a-8 t t l
Title: Q-r /os Driver`s license
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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