HomeMy WebLinkAboutStreet Cut Permits 17 Pam Lane (2) 1300132 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/14/2013
GIS ID: 68700017 = FEE: 25.00
MUNIS APPLICATION# 201300819
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EXPIRATION DATE: 06/14/2014
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APPLICAN ! = LOCATION
NAME: BOUTIN&SONS M PA- AftANE
ADDRESS: 121 WINDSORVILLE"
f SOIRA�BENDORF DENNIS T&SUSAN R
BROAD BROOK, CT16b �/
1a TAM ,ANE
a j-POP WINDSOR,CT 06074
PHONE 860-623-2526
30
WORK DESCRIPTION: DRIB
APPLICANT AGREES TO FURNISH THE%VoW QUTI
AMC?'C'I'fL ftoB-OND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN`E%P N 1n�G � I 1 1R AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI~ Pj 1NT�TS M-- � ?A W L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO WN OF6iTUI1aIj�g PIT MANUAL.
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ISSUED BY DAT- ACTED INSPECTED BY
6/14/2013 11:54 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: f 3 bd 13.�--)- CONTRACTOR: ,6 D y.' 10
LOCATION: - ---�.e� Y�-P
TYPE OF WORK:
DATE INSP NEEDED. DATE INSP: i
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED_ WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
`w APPLICATION FORSTREET� EXCAVATION PERMIT
N OF SOUTH WINDSOR
PUBLIC- WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN. AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Boutin & Sons Cons t. Co. Phone No. 623-2526
AddressofFirm 221 Windsorville Road roa rook, Conn
Location of proposed work /7 Q/y1 ICEAe—
Describe fully nature of permit requested (a- ALiz
Starting date Approx.time for completion_2LO
Call before you dig no. Traffic Services Control No.
Show sketch of proposed work or furnish TO be filled out by Town of So. 'Windsor
two copies of separate drawing Pavement Cut
Indicate North Prop.size of cut
- No.cuts
Amt.of Deposit$ by
O Cash(J 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
1 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.
4)Signed: Date:
Title• D.L.#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
. FRIDAY 12:00 �
SOUTIN & SONS PAVING COMPANY, INC.
121 Windsorville Road, Broad Brook, Connecticut 06016
Tel. (860) 623-2526 Consumer Protection Reg.#500258
05/09/13
Date of Call: Scheduled Work Date:
Date of Estimate: 05/10/13 Completion Date:
Date of Acceptance: Ll /✓'
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Name: SUSAN SCHWALBENDORF Grav
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— '7 °Alm
Address::
SOUTH WINDSOR
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Tee PHONE 860-644-1105 No
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Job Location: j e f , l�r LZ
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Description:
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PLEASE NOTE: DUE TO"CURRENT VOLATILITY OF LIQUID ASPHALT PRICES,
CONTRACT PRICES- WILL BE SUBJECT TO ANY PLANT MATERIAL CHARGES.
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Quote Good for#b ays. • ' • '•
Special Attention: 1/2 Payment Upon Starting, Balance Upon Completion.
Contract ; 5- �' / Permit
ONE YEAR GUARANTEE ON WORKMANSHIP & MATERIALS. Pres.
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CBUD
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