HomeMy WebLinkAboutDriveway Street Cut Permits 96 Gordon Dr V -
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3871 Cont;.;ra;t*ltor AIROt*f)T,f:, :.
wS INC.
Location 0096 GORDON DRIVE
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Type Work DRIVEWAYuxH TI>NDO$ C3, 06074
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Permit No. 3871 Town of South Windsor, CT
Date 10/08/2004 Street Excavation Permit
Expiration Date 10/08/2005
Descrip:
Applicant
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Name AIROLDI'S INC05�,CzC?RDO21 t?12T�7E"
Addr. P O BOX 71
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SOUTH
WINDSOR C :,0..6,.07:4
Phone (860)289-3876 r r
Applicant agrees tG`tu as the .i
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required and to reimburse Che down of Sq'�1 #�fxkdsor EoYr�r 'expzses
incurred by the Tov7n :: b.r tdasrxbsn xs C�nneQE1 n with this
permit and that aPP'lic.aht
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regulations for erne",.."::::� '',:.; :. :.;'., ..:.:.:..: ... ;<:<:'`
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P zts asou:t: Yxteci> at1a '7'S.orIi: W'in3's.csrIs„ Street
Cut Permit Manual.
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Date Completed BY
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm �`� �` Phone No.
Address of Firm �'
Location of proposed workyz
Describe fully nature of permit requested
Starting date Approx.time for completion
Call Before You Dig No. " Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
p Amt.of Deposit$ by
()Cash()Check#
1 Cut size after Perm. Patch
No. Cuts
.� Final Billing $
Amt. Due Payee$
�? Amt. Due Town$
Applicant is responsible tadbisa\ Sj 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:
c_ D.L.#:
Title:
PERMIT SHALL BE KEPT ON 30BME AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc