HomeMy WebLinkAboutDriveway Street Cut Permits 162 Fairview TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No, 3766 Contra`C'tor AIR6hbl kS. INC.
Location 0162 FAIRVIEW DRIVE
,,Address; P O SOX;<:71
Type Work DRIVEWAY SOUTH WINDSOR CT; 06074
Phone No
Date Insp Needed _ Date Ia:sy
Time Insp Needed _ _ Time Ip
Inspected By A�LG� ld
Work in Progress �c
Permit No, 3766 Town of South Windsor, CT
Date 06/17/2004 Street Excavation Permit
Expiration Date 06/17/2005
Descrip:
Applicant
Locat.,n
Name AIROLDI'S INC. 01-6'2 FAIRVIEW .D.RIVE
Addr. P 0 BOX 71
SOUTH WINDSOR CT 0607,4 Ty ne of ;C<yYkc J3RIVEWAY.
Phone (860)289-3876 r
Applicant agrees: to „futrnisli'the Torn t.f .Sagft WindStrr the:;amount of bond
required and to reilnkytirs4:. the „TOWS off; $pLltll W�nds'or for apy>:expe''nses
incurred by the Town fcsr }ga�ntenance"'or rair Work in'::conn ,pti<in with this
ep
permit and that appl'ic:an't xs.familaar' Wah' 0 will a 'i.'do bY 'te rules and
regulations for permits as ontj.ined i t:heoWn"of Saut'h Wa;tdsor s Street
Cut Permit Manual.
* * PERMIT TO'$E If 'P ON::JOB SISE AT,.,AI,I; TI'ME'S.
n
Issued by
Date Completed _----_--_--_ Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Phone No. C
Address of R '--\
Location of proposed work
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig N6,-g:: .s��-�c�"1�` Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts
Amt.of Deposit$ by
O 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. Dater
Title:- D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc