HomeMy WebLinkAboutDriveway Street Cut Permits 819 Ellingto TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No
Location Contza:etor AIROTDi>e INC.
Address Type Work DRIVEWAY ' P 0,`SO
�',71
SOUTH d11NJ� OR C 06074
Phor�s njo (gip)2f39 3&:76
Date Insp Needed X.
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Time Ins T
p Needed
Inspected By f
Work in Progress
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i Permit No
Date 4317
10/17/2006
Expiration Date
Town
Descrlp: RE 10/17/2007 Stre i
of South
Windso
CT
PAVE DRIVE :. : et ExcaVat r�
WAY on Permi t
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Name AIROLDI,S
Addr. P INC. r a
O BOX ca 711
SOUTH Phone (860 28IXDSOR 0 0 g 0819 ELLINGTC3I7 ROAD3876
2Y1�e of brk i3R2VEWAy ::::.
Applicant
re4uir agreed to
incurred and to re1� ureII�sh. the Tt)wn pf
Permit and Yt the Town. for h oiufouhoti W'nds°r t
regulations that
appl cant its anCe or, re 1:: c. x for anhe a:m°unt of bond
Cut per for permitstiXar Parr Work ino Ype'nses
mit Manual. a ° CZink� a wfr on w•
ed �R Che Tote of gozde by the rules this
* * PER TO th,W�ndisor s
MIT Streetd
Issued by ( EE K PH .pN 0OB SITE AT ALL .TT
Date Completed
�L
Inspected BY
�r APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
' PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm C\�� � S —�tv
Phone No.
Address of Firm o _ �o \ �"� �i.s o� C q 6 a r1 I'
Location of proposed work
Describe fully nature of permit requested
Starting date Approx. time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out b
Town of South Windsor
- Pavement Cut
No. cuts
Est. Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est. Unit Price$
Amt. of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s).
Final Billing
Amt. Due Payee
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 THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITk\ ,�UTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
Date:
Title: QZ5 Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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