HomeMy WebLinkAboutStreet Cut Permits 165 Scantic Meadow Ro (2) 1100066 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/24/11
GIS ID: 81000165 FEE: 25.00
MUNIS APPLICATION# 201100651 , ; - - EXPIRATION DATE: 06/23/12
APPLICANT - LOCATION
NAME: M&S PAVING AND SEALING,INC, ADDRESS: 165-SCANTIC MEADOW ROAD
ADDRESS: I 1 I COMMERCE WAY - OWNER: HOGAN JOHN H JR&JEAN A
SOUTH WINDSOR,CT 06074 ; 165 SCANTIC MEADOW
SOUTH WINDSOR,CT 06074
PHONE 860-648-1915
WORK DESCRIPTION: DRIVEWAY_--
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WII±ID�OR TLIE AMQUNT OF BAND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED$YTHE WI*I TOFOP,--MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICAN IS FAIv11L,IAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSR'S STREET CUT PERMIT MANUAL.
ISSUED BY �-,6A l E INS ECTED INSPECTED BY
6/24/201111:27AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I l -006 r; CONTRACTOR: M 1+S
LOCATION: 1 ( ,S7 S<.�✓�'ri< +/1'�iP�cQhu7 ��
TYPE OF WORK:-
DATE INSP NEEDED: DATE INSP: /
INSPECTED BY: �
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: - (�
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm % S ,ap-% xe phone No. 9ce - L-`�l 8 -l g CS
AddressofFirm kx\
Location of proposed work t LP-S 5 C Gt A.-i -T--3 C w,E as o o 2
Describe fully nature of permit requested
Starting date - Approx.time for completion Co o 0,01�-y S
Call Before You Dig No. co 0 Traffic Services Control No.
Show sketch of proposed pro we ork or furnish This section to be filled out by
two copies of separate drawing Indicate North
Town of;outh'Windsc,r
Pavement Cut
No.cuts
0 i
Est.Size of Perm.Patch(s)
CO Est.Pvt.Thickness in.
I Est.Unit Price$ _
Amt.of Deposit$
Total Due$ by
Cash{ )Check#_
Permanent Patch
No. Cuts
Size of Patch(s)
x
Final Billing
$
Aint, Duo 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
TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AN4 TH MILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLINED IN THE TOWN' F S UTH INDSOR'S STREET CUT PERMIT MANUAL.
Signed: -- Date:
Title: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES