HomeMy WebLinkAboutDriveway Street Cut Permits 10 Benjamin r
Permit No. 3906 Town of South Windsor, CT
Date 03/28/2005 Street Excavation Permit
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Expiration Date 03/28/2006.;
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Applicant�r
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Name AIROLDI'S INC. >4. 5NJANY7A'1;,
Addr. P O BOX 71
SOUTH WINDSOR r 106174 f }` ..Qf' WOl� �IJ,.aWAY'
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Phone 860 289-3876
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Applicant agreed :,�,q<; �uz3� s2i>::�:��;;,,: 'h. Win .�b'�..,�h� �a�riount of bond
required and to re mbuse tJ Tow �3� sc� r .c�x_ n :."expenses
incurred by the Tov;+ii`fp:s `ina' ht<eaan_��_��;..,a;' , •,a;''.�y;;.��Y"fc,.. li`':e'oriY�lactVion with this
permit and that applicant -is "94%2. Jafl.l :2, a xd ` by :the rules and
regulations for permits ,.; t` 3v. of.;rpfiit'h 'incisor's Street
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Cut Permit Manual.
* * PERMIT T0 '$ TCFx :;OWN JOH' g:ITE^>X'T: ALL 'I>T'MES.
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Issued by --- -----------------
Date Completed ----------------- Inspected By
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3906 C.9if ractq.� AI'R€. 1,DIi�&:<,ZNC.
Location 0010 PJ1MN WAY Addxe �P 0 $Cf 71.,
Type Work DRIVEWAY y , T WIN SCR CT.; 06074
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOk CT
FEE $25.00
Name of Firm Phone No. ` - �s
Address of Firm .
Location of proposed work
Describe fully nature of permit requested
Starting date va\Lt\ S Approx.time for completion �\ �—
Call Before You Dig No�c�.c��l'?ctii" � l Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
,
No.cuts
Amt.of Deposit$ by
()Cash(}Check#
Cut 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 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:,, Date:
Title:
D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc