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Permit No. 4026 Town of South Windsor, CT
Date 07/05/2005 Street Excavation Permit
Expiration Date 07/05/2006
Descrip:
Applicant . °< Loca: iqn
Name AIROLDI'S INC. 1 ::E16"1;2._..:BEELZE:U-B,..pC3AD
Addr. P 0 BOX 71
zQ 6474SOUTH WINDSOR C k D,kIV AY
Phone (860)289-3876
Applicant agrees to furnish the;;<.'* t a "both Win'i3sor th'e-�imbunt of bond
required and to re�.m, u.rse .ths`: Tows c3 a# I A2 x�eor fqr any expenses
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incurred by the Town :.for ma�nbenance or "r"epair"wo)p i7s coni7gct:ion with this
permit and that applicant is ;famil 'a: ;;dZ; lYd gill a_bzde>by :the rules and
regulations for permits as outlincl; n theA�tt1 of South sor's Street
Cut Permit Manual.
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* * PERMIT TO--BE K-8F'T ON 30B :SI F AT Y S TIMES.
Title .:Issued by / _
Date Completed _________________ Inspected By _________
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4026 Con..t:ractor AIROLDI`I'S.>.-INC.
Location 0012 BEELZEBUB ROAD Add.re$$ :P O $lOX 71
Type Work DRIVEWAY flGUTHWTND50It CT,...06074
Phone."No
Date Insp Needed Dates Tnsp
Time Insp Needed __�� T1me. In
Inspected By
1J Work in Progress one
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Fi _--� .; Phone No.
w" ` ``�' ., :.>
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Address of Firm
Location of proposed ork
Describe fully nature of permit requested
Starting date _ ____Approx.time for completion cU, —
Call Before You Dig No,r c, Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
1 O Cash ( )Check#
QCut size after Perm. Patch
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
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH T
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
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Signed: Date: ( 1
,el—.^"__.-." D.L.#:
Title:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc