HomeMy WebLinkAboutDriveway Street Cut Permit 56 Greenfield 700105 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 07/11/07
GIS ID:38400056 FEE
MNIS APPLICATION# 200701067 ¢ ++`` 25.00
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. EXPIRATION DATE: 07/10/08
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APPLICANT
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NAME: AIROLDIS INC C
?' <'< >' Cy�2ESS <;`.`+ 6' ME DRIVE 1
ADDRESS: BOX 71
' ATORE MICHAEL J SV &CATHERINE P
S WINDSOR,CT 060 -... .:;:;.
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:. �i ;G ErT�'IELD DRIVE
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SIT *SO CT 06
074
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WORK DE
SCRIPTION:
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APPLI
CANT
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REES
ES TO FU
RNISH
SH THE TOWN
0P.::�S�II'TH>:�
O. REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANV..,E I3,FNSE ,II�F :.:; tA TTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THi>AI T'01c., '17 ?F1 ; H> Np_WItt SIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN&:s.d :•' P R1v1IT>MANUAL.
ISSUE BY DATE-1. .:;EC T°F INSPECTED BY
7/11/20072:35PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** \ ���
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00 (41
Name of Firm 14 0 C— Phone No.
Address of Firm U OJT 3 1 c-L rN C--F—
Location of proposed work 56 Z tJ 1 V-D,SOC; C .
Describe fully nature of permit requested tfCP/-Q(2 r:-A-1&-2J7- ,e t t)r2j
Starting date 7l ` - D -7 Approx. time for completion _ ��' -7
Call Before You Dig No. oZUU 7 -57-v Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
C-4 No. cuts
_ �\ 0 Est. Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est. Unit Price$
Amt. of Deposit$
Total Due$ by
( )Cash ( ) Check#
Permanent Patch
No. Cuts
Size of Patch(s)
i
i
Final Billing
$
Amt. Due Payee j
I
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 IS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLIN IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: k-LDate: -7L-, I t J -7
Title: C9,qA Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Sketch o`f Driveway
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: —7 DQ I O<-,_ CONTRACTOR:
y .. LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP• c b,/0$
INSPECTED BY:
WORK IN
PROGRESS:
C
AS-BUILT:
INPUT:
DATE.
W/2007 Town of South Windsor INPSECTION REPORT 07