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HomeMy WebLinkAboutStreet Cut Permits 866 Foster Street (2) 1200171 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER STREET CUT PERMIT DATE: 09/11/12 ; GIS ID: 33600866 )l/ FEE: 25.00 Mi_T_NT_S_A_P_P_T_TC�T_Tl17.T_1�2���ni_I an- .r, .��-- ----- AF APPLICANT" = = = LOCATION NAME: BOUTIN&SONS ADDRESS 8�6 FOSTER STREET ADDRESS: 121 WINDSORVILLERU ER F % PIEROG DIANE TRUSTEE BROAD BROOK, CT 06 6 _ 94 ©S 'ER STREET 1 } TTH Ar NDSOR,CT 06074 PHONE 860-623-2526 WORK DESCRIPTION: DRIVEWAY APPLICANT AGREES TO FURNISH THE TOWN OI SOUTII WI ?SQI TIDE-rkMO CJI T OF B01b REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH WINDSOR FOR A*IPEISES TNGLREB HE TOWN FOR 11AINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND TI&A tfk.CAI�IT IS I III 1AL WITTI AI`Ill WTT ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OFOiTH WINDSSTREEI CUB PERfYI MANUAL. ISSUED BY DRAT-E 1NSPE `TED INSPECTED BY 9/11/2012 3:17 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** TOWN OF SOUTH WINDSOR INSPECTION REPORT 6 PERMIT NO.: 01 CONTRACTOR: lJ-tl LOCATION: ,s TYPE OF WORK: DATE INSP NEEDED: DATE INSP: Q -2 9 -13 INSPECTED BY: WORK IN PROGRESS: �n -e --� J �" SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO AS-BUILT: INPUT: _ DATE: S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION Y APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLIC• WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN. AVENUE SST ITN 17VTND-'R R_-_ CT FEE . 25.00 Name of Firm Boutin & Sons Cons t. Co. Phone No. 623-2526 06016 Address of Firm 121 Windsorvi e Roadroa rook, Conn Location of proposed work- �7 JA Fa s Tc i S T —CX T Describe fully nature of permit requested d e in,,/ c/ lee is Tip+g A.2 irJet. u Starting date 9 - Z O -/Z. Approx.time for completion /o - Z a-/z Call before you dig no. F 6 / Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town of So. with! two copies of separate drawing Pavement Cut Indicate North Prop.size of cut No.cuts Amt.of Deposit S by (D Cash O Check# Cut size after Perm. Patch No.Cuts Final Billing $ Amt. Due Payee $ Amt,Due Town .$ 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 I 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: Date: 9 Z Title: C� / ds D.L.# ~ PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES B UTIN & SONS PAVING COMPANY INC. 121 Windsorville Road, Broad Brook, Connecticut 06016 Tel. (860) 623-2526 Consumer Protection Reg.#500258 Date of Call:. ' �. Scheduled Work Date: Date of Estimate: _ / �� Bc Date of Acceptance: P, Name: re,-- i e, G — Lj Address:: 2F,v/ E — Tel: ' "L' 4,/ _ f — f L� Directions: C` 1 Description: cO 41 Quote Good for Days. cm Special Attention: 1/2 Payment Upon Starting, Balance Upon Completion. Contract Permit ONE YEAR GUARANTEE ON WORKMANSHIP & MATERIALS. Pres. CBUD ,:2, 25(�Ga d +i°� Date f� J