HomeMy WebLinkAboutStreet Cut Permits 20 Diane Drive (2) 1100171 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/25/11
GIS ID:28200020 FEE: 25.00
MUNIS APPLICATION# 201101254 EXPIRATION DATE: 10/24/12
APPLICANT" ," , LOCATION
NAME: BOUTIN&SONS ADDRESS, 20 INANE DRIVE
ADDRESS: 121 WINDSORVILLE ROAD OWItBR. PHAM NIAN&
BROAD BROOK,CT 6616 20--DIANE DRIVE
PHONE 860-623-2526
OUTH WINDSOR,CT 06074
- �"
WORK DESCRIPTION: DRIVEWtY
APPLICANT AGREES TO FURNISH THE TE)WI pF SOUTH WIIDSE7R TEIE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANtEk'ENSE8 INCURRED BY THE TOWN ROR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT IS RAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSR'S&TREET Ct"ER-,MIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
10/25/20119:32AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: / O C 71 CONTRACTOR: 60(tlill
LOCATION: 0� 0 T:�>', a v') , _tr 1
"TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 6
WORK IN
PROGRESS: b c,.
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
PUBLIC- WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN.AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Boutin & Sons Cons t. Co. Phone No. 623-2526
Address of Firm 121 Windsorville Road roa rook, Conn 06016
Location of proposed work_ _20 D i a n e Dr i vP
Describe fully nature of permit requested Stri n exxi c ti naZ dri yewa�,, dig out lawn area, add
_ process gravel grade, roll and nave.
Starting date 11/7/1 1 Approx.time for completion
Call before you dig no. 2 0114 30117 7 Traffic Services Control No.
Show sketch of proposed work or furnish TO be filled out by Town of So. Windsor
two copies of sep rate drawing Pavement Cut
Indicate Nor 19 Prop.size of cut
No.cuts
1 1 Amt.of Deposit S by
O Cash O Check#
5 ��l Cut size after Perm. Patch
No.Cuts
Final Billing S
> Amt. Due Payee S
Amt.Due Town S
Applicant is resp nsbte for'contacting
the Police Dept. nd C.B.Y.Ii, 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 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.
Signed:. &64tJ Date:
Title e ele I!✓ D.L.# `
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES