HomeMy WebLinkAboutStreet Cut Permits 1790 Ellington Road (2) 1200221 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 11/05/12 r
GIS ID: 30301790 FEE: 25.00
MUN__IS_A_P_P_L.TC A_T_TC W_tt 2n 1_21)1 AQn — 11/05/13
APPLICANT - LOCATION
NAME: M&S PAVING AND SEALING,INC- ApDRES` i Ott INGTON ROAD
ADDRESS: 111 COMMERCE WAY ��iEI� = WAPPIIG COMMUNITY CHURCH INC
SOUTH WINDSOR,O LI;INGTON ROAD
Sfl TTH PHONE 860-648-1915 -
WINDSOR, CT 06074
_
WORK DESCRIPTION: REMOVI REP, E LS PER APPROVED
TOWN PLANS ASD=PFN�'rCES
APPLICANT AGREES TO FURNISH THE TO Wad OF SOUTH,V ND I AMOUI pE BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY.EXPENSES, AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THi APISLICANT IS FA3VIII IAR WITH�kND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUT,4
WINDER—T MANUAL.
ISSUED BY DATINSPCTED INSPECTED BY
I1/5/201210:24AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:— ® ^
TYPE OF WORK: fzp 0 la c c 7D IrLs - I I yw w 1��
Vor D town
DATE INSP NEEDED: DATE INSP: f "
INSPECTED BY: P.
WORK IN
PROGRESS: -7)e-, f"/r,;1
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ L` DATE:__
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET PXCAYATION PERMIT
TOWN OF S4t7TH WtNDSOR Permit No.
PUBLIC WORK&kIiARTNIBNT
TOWN HAS!
11540 StlLL(VAN AVINU
soUTH�v1t�l�sR,c`r o074
l EE :oo /
Name of Firm r 3 /l Phone No, Rob-, jr(04- 1` 1
Address of Firm
Location of propo d work
Describe fully nature of permit requested E&I I T ltl
LJ �11�
Starting date ) - -J Approx., time for comptetton_ .Jam. I-Jd--
Call Before You Dig No.�Q/�2.__ Traffic Services ControMb
Show sketch of proposed work or furnish This-se totj,to,bee in by
two copies of separate drawing Indicate North fiowQ ofSaufhaNlhdsor
Pavement Cut
No.cuts
Est.Size of Petm.Patch(s)
Est,Pvt.Thickness In.
I Est.Unit Price$'
Amt.of Deposit.$
Total Due$ by
j O-cash( )Check#
Permanent Patch
No. Cuts
Sizeof Patah(s)`
�instL3iUing
Amt.Due 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 °Nib RE�tUIRED.AND 70 REIMBURSE.THE
TOWN OF SOUTH WINDSOR FOR ANY EXPENSES fNc(1RRED BY THE TOWN F,N WINTENANCe OR:REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THAT I AM F Mtt lAR WIi FtANt =1rU.fl L Alt 8Y°FHA RULES AND REGULAfiIONS FOR
PFRMiTS AS OUTLINED! THE TOWN OF SOUTH WiNDStJR'S STREET CUT P f+AlT MANUAL.
j
L,d Date: JC>31- 0
Title: . Driver's License tk
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES