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` TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3706 Contxadt:.or AIROtT)'I':;5„ INC.
Location 0179 HILLSIDE DRIVE Addre� P O,BOX 71
Type Work DRIVEWAY SOUTH W'IND,SOR C:T. 06074
Phone Nd ;C. 0401
Date Insp Needed
Time Insp Needed ( x�
J.
Inspected By ��
Work in Progress
Input �1_ Date -1I 4,0
Permit No. 3706 Town of South Windsor, CT
Date 05/18/2004 Street Excavation Permit
Expiration Date 05/18/2005
Descrip:
Applicant Location
Name AIROLDI S INC Z79 ITI.LLSIDE IYRjV.E
Addr. P O BOX 71
SOUTH WINDSOR Cr Q6074 T � f, Work `DI2TVEWAY
Phone (860)896-0401
Applicant agreed to,.furxt3sh the qwn, South W11118: r ttie olint of bond
required and to reifmb,ursi� the "own of Sou:th 1, sor for 'ariy expenses
incurred by the Town f:or ma ten zpe off' repair= work 1 cozh: ection with this
permit and that applicant isfmi�.lr aa, h arid;; waZ1", bde by the rules and
mit as ou . f th : or s Streetregulations for per
wd
Cut Permit Manual
* * PERMIT'TO $E;,KEP aN JD$;: SITE, A£ IaL TIMES"
Issued by
Date CompletedTnspec;ted
1 ob
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm �,�c�_ ®� . ci Phone No.� ?���—
Address of Firm-,--,
Location of proposed work
Describe fully nature of permit requested
Starting date v_'c� � _Approx.time for completion ` '
Call Before You Dig No Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
No. cuts
Amt. of Deposit$ by
( )Cash ( )Check#
Cut size after Perm. Patch
No. Cuts
Final Billing $
Amt. Due Payee$
Amt. Due Town $
Applicant is responsibl 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 Date: =' .
D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc