HomeMy WebLinkAboutDriveway Street Cut Permits 726 Avery St Permit No, 3596
Date Town of South Windsor, CT 09/23/2003
Street Excavation Permit
Expiration Date 09/22/2004
Descrip:
Applicant
Location
Name AIROLDI'S INC
0726 ,EVERY STREET
Addr. 41 ZINFANDEL CIRCLE
TOLLAND CT 06084 Type fPhone .W DRIVEWAY Applicant agrees to:;fLtrna s'h the <:TovXx; ciftxtth Windsor the amount of bond
required and to reimburse the. Town tafo ;th Wi#: sorox any expenses
incurred by the Town for ttta �itenan ses
ce or repair wox7 in conrieexpen with this
permit and that applicant is' famili`ar wih arid:"w�Xl abide „by the rules and
regulations for permits as ou., ined xn the TotBn of South Windsor's Street Cut Permit Manual.
* * PERMIT TO RE`KEFT ON 7OB BTTE AT ALL TIMES.
Issued by ---_—
i
Title
Date Completed -------------- Inspected By .
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3596 Contractor I IROLDT.!%S INC.
Location 0726 AVERY STREET .Address; 41 ZIN�ANDEL.. CIRCLE
Type Work DRIVEWAY TpLLANIT:CTZ 0608'4
Phone No (B U.).896 0401
Date Insp Needed ------------- Date Lrzspp-{�
Time Insp Needed 0
-------- Time I
--- - -
Inspected By 1� _
Work in Progress
Inputr Date ---�_sL_1.�+7_
APPLICATION FOR STREET EXCAVATION PERMIT (p
TOWN OF SOUTH WINDSOR 3
PUBLIC WORKS DEPARTMENT
TOWN HALL
1S40 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $2S.00
Name of Firm A iT01&- 5 "Tn C Phone No. oP g9 3 8 7 Ce
Address of Firm ® Q)0 lc 9 W%r-'ASer
Location of proposed work `talc Avert-1, S-�r �-E
Describe fully nature of permit requested
Starting date ro V 9 - -O Approx.time for completion iD- A(3 - 03 A-;oen)e
Call Before You Dig No.a003- 3 R'D.)7 7 8 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing GPIRPIGE
Pavement Cut
Indicate North Prop. size of cut
No.cuts
I \Z Amt.of Deposit$ by
V
O Cash O Check#
c "e
Cut size after Perm. Patch
oZ No. Cuts
Final Billing $
Amt. Due Payee$
Amt. Due Town $
Applicant is responsible for contacting by 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 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: .92 Date:
Title: D.L.#: R It-
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
BOND TOWN`OF SOUTH WINDSOR
Am't Req. PUBLIC WORKS DEPARTMENT
Date
TOWN HALL
't on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Ftermit Expires
APPLICATION FOR PERMIT
FEE $10.00.•
Name and address of applicant �: - � Phone No.
Location of proposed work ? r ; ;,. P
Describe fully nature of permit requested ;r--r__
a
Insurance on file with Town 'yes no Date policy expires
Name of Insurer
o Approximate time for completion Desired starting date
�d
u Show sketch of proposed work or furnish 2 copies of separate drawings
.Q.
E
a � i
o '
° �J �1
0
U
Applicant is responsible for contAct!t site Police Department and CALL BEFORE YOU DIG.
I agree to furnish to **_T6wn of South Windsor the amount of bond or deposit required and to
reimburse the Town of -1outh Witdssor fmr any expenses incurred by the Town for maintenance or repair
work in connection with this pemdt�-and that I am familiar with and will ab* ' by the rules and
regulations for permits,as outllneO inthe Town of South Windsor's (Pavem�nt%'Ciit RegulaEions.
Signed
APPROVED. DATE APPROVED• - ATE X!)
Supt. of Highways o n Engineer"
FOR INSPECTOR: Date work started Date completed
Sufficient notification received: yes no Type of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector