HomeMy WebLinkAboutScanned on 05/04/2012 at 10:46:39 1100044 TOWI, OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/09/11 -,
GIS ID: 88800092 FEE: 25.00
MUNIS APPLICATION# 201100413 E 'IRATION DATE: 05/08/12
APPLICANT = LOCATION
NAME: M&S PAVING AND STALING,INC DRESS:-, 92 SYCAMORE ROAD
ADDRESS: 435 BUCKLAND ROADai 4R EDVRDS RICHARD&SHAWNA
SOUTH WINDSOR,GT Q6074 92 SPCA MORE ROAD
OUT WINDSOR,CT 06074
PHONE 860-648-1915
57
WORK DESCRIPTION: DRIVEWAY
APPLICANT AGREES TO FURNISH THE TOWhNT OF SOUTH Sf7R TIC AMOLJI4IT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY`EXP ?4ISE8 INCURRED$Y THE TOWN FOR.MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT IS FAM IAR KITH ANDS 1-- L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SQJTB WIND41r S STREETCUTPERIVIIT MANUAL.
yno //o
5
ISSUED BY DATE INSPECTED INSPECTED BY
5/9/201111:43AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMITNO.: 8b009V CONTRACTOR: M+ S ]"
LOCATION: a S mof e
TYPE OF WORK: D, \fie• a
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: i3.lb
WORK IN
PROGRESS: >.�.
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C� DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT 11 oP0Vq
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm 1`n + 45
-- - PAJI� a � . S E `-1 `JP�,
one } (Qd
No.
Address of Firm \\ Cow \ n C-O�c
Location of proposed work �i '7'L- S
Describe fully nature of permit requestednlr=llL
�,►t n
Starting date 1 l Approx.time for completion (S _
Call Before You Dig No. t ( `-1 00`-i 5 a Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
0 No.cuts
Est.Size of Perm.Patch(s)
i
Est.Pvt.Thickness in.
I �J' Est.Unit Price$
I / Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
11 Permanent Patch
dJ ��
No. Cuts
Size of Patch(s)
Final Billing
7-3r , ,-U"7W- Amt.Due Payee
g
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 PE AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMI AS OUTLINED IN TH •OWN OF SOUTH WINDSOR'S STREET CUTPERMIT MANUAL.
Date:. o�-
tTiti . Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES