HomeMy WebLinkAboutDriveway Street Cut Permits 82 Farmstead TOWN OF SOUTH WINDSOR INSPECTION REPORT
c
Permit No. 7 $ Contraci�''r X TROLDI"S INC.
Location
Address P O.-BOX: 71'
Type Work DRIVEWAY SOUTH MINI JSOR'" T 06074
Phone No ,'(860)8.96 0;401
Date Insp Needed
-------—--
at. Izasp
Time Insp Needed _------ Time ZSis
Inspected By --_---
Work in Progress _— — �
12
X.
Input _ Date _ 7
✓ Permit No. 7758
Date 06/14/2004 Town of South Windsor, CT
Street Excavation Permit
Expiration Date 06/14/2005
Descrip;
Applicant
Lo'cati"�n
Name AIROLDI'S INC
Addr. P 0 BOX 71A8t2 FARMSTAD ,DRIVE
SOUTH WINDSOR CT .'g6074
Phone (860)896-0401pe 'idol DRIVEWAY
Applicant agrees to furnish the �gvt�,.Qf gauth Winds
required and to re1mbsirs the To rr of pz ,thy amount of bond
incurred by the Town for moutluds°r for'a'ny e- pnses
permit and that a dot nance or repair wcsr]s,;; in onnecti'on with this
Prmlcant Ys f��tt 3ia tla xsi3 gill' abide by t;h rules and
regulations for permits as outlined zn' the 'Totvp of 'South Windsor s Street
Cut Permit Manual
* * PERMIT TO' B
ALL TIMES.
Issued b
y
y=- ---
Date Completed
--------------- Inspected By
• J� APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Phone No.
Address of Firm
Location of proposed work �—
Describe fully nature of permit requested14 \
Starting date 'L\��\�=ma y Approx.time for comnplet;on
Call Before You Dig No;-,A=� Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
()Cash ( )Check#
Cut size after Perm. Patch
No. Cuts
Final Billing $
Amt. Due Payee$
Amt. Due Town $
Applicant is responsible for I I 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: U
Title: D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc