HomeMy WebLinkAboutDriveway Street Cut Permits 178 Hillside TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3759 Con rac'C`'or ' f)CbM'D1!;,.S INC.
Location 0178 HILLSIDE DRIVE A'ddres;$ „ P 0 bOX 71 <
Type Work DRIVEWAY SOUTH WINZ)SOR "Q:T 06074
'Phone No (s36r0.)896 0.:401 ;
Date Insp Needed batey� p
Time Insp Needed _--__— Time ZX#S
Inspected By
Work in Progress
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Permit No. 3759 Town of South Windsor, CT
Date 06/14/2004 Street Excavation Permit
Expiration Date 06/14/2005
Descrip: CK 8066 $50.00 2PERMITS
Applicant Ufl,.(;at.ion
Name AIROLDI S INC. XXXt & HLTSIDE bFIVE ;'
Addr. P 0 BOX 71
SOUTH WINDSOR CT 060 F4 Typ''e Wor. DRIVEWAY
Phone (860) 896-0401
Applicant agreed to E.urxx�s-13;h the T. wra Off; South Wir**dsp the amount of bond
required and to reimburse the Town of Sot�tl� Windsor for dny ;expenses
incurred by the Town for!?.Main ellA:atO briiork in. connection with this
permit and that applicant is familaar witl: and :xvill abyde by the rules and
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regulations for permits 'as out: xMed a;3x thy; Tc w�a.;o Sol th'Wi ridscir s Street
Cut Permit Manual.
* * PERMIT TO BE KEPT ON , 0B :T$ ITT.` PLL,T„'IMfiS;
Issued by — Title
Date Completed d By;nspetted
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSORF CT
FEE $25.00
Name of Firrn����-----, Phone No.
Address of Firm� "�-c,;� '�\ �� ;��\ k—
Location of proposed work
Describe fully nature of permit request i—N
Starting date_ Approx.time for completion
Call Before You Dig No. � cfk Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No.cuts
Amt. of Deposit$ by
O Cash O 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'\. , ��c�� Date:
Title:• D.L.#:
PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc