HomeMy WebLinkAboutStreet Cut Permits 162 Palmer Drive (2) 1200156 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/27/12
GIS ID_68400162
-- - - - - - - FEE - - - 25 on
MUNIS APPLICATION# 201201097 `JXPIRATION DATE: 08/27/13
APPLICANT LOCATION
NAME: BOUTIN&SONS AIbI�ESS: 162AMER DRIVE
ADDRESS: 121 WINDSORVILLE-A AID = = pWNER IvI LAWRENCE J&CLARE L
BROAD BROOK, CT,06ffl6 P11 16 - MER DRIVE
`/ S-OUTH WINDSOR,CT 06074
PHONE 860-623-2526 --
WORK DESCRIPTION: DRIVE-__A
APPLICANT AGREES TO FURNISH THE I OWN OF SOUTH INDS4?R fiFIE AM0IJNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY- I'EIVSES III®- T-,- FC)R MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APF'LIbANTT 7- $S FAMILIAR VtFITI ANDVIL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO N OE SOUTH WINDSR S STREET'CUT I'ER1lITT MANUAL.
'3
ISSUED BY D1 INSPECTED INSPECTED BY
8/27/2012 12:22 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 60I S6 CONTRACTOR: goo) 1-J AJ
LOCATION:-- ff bnjve
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: /5-
INSPECTED BY: 9D
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: f_ DATE: 17- /
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC- WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN. AVENUE
SOUTH WINDSOR,
FEE $25.00
Name of Firm Boutin & Sons Const. Co. Phone No. 623-2526
Address of Firm 121 Windsorvi e Roa roa rook, Conn
Location of proposed work „;' � ,7-j r 7r�UG
Describe fully nature of permit requested
Starting date ' / ,Z Approx.time for completion f s s
Call before you dig no. du 3 11 /9 2 3 Traffic Services Control No.
Show sketch of proposed work or furnish TO be filled out by Town of So. 'Windsor
two copies of separate drawing Pavement Cut
. A
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit S by
O Cash O Check#
Cut size after Perm. Patch
No.Cuts
Final Billing$
Amt.Due Payee S
Amt.Due Town S
Applicant is responsible for contacting
the Police.Dept.and C.B.Y.D. 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: 7 - Date:
Title: 1 L G/e, 0< / / D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES