HomeMy WebLinkAboutDriveway Street Cut Permits 16 Kupchunos TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 404,8 Cont:LaCt"5 AM`0'LQ-T,'S INC. /
Location 0016 I a r3clr.er.
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Type Work DRIVEWAY
;t #::SOUTH"T7II�9SOR'`aT 06074
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Permit No. 4048 Town of South Windsor, CT
Date 07/26/2005 Street Excavation Permit
Expiration Date 07/26/2006 ,.:
Descrip:
'a;sk't: •:
Applicant
I�o'Ci�>t` :on
p ;....
... ....: : .
Name AIROLDI'S INC.
"'`"s>'" KUPCHUk�O$/D�I�7E`'
Addr. P O BOX 71
Y' 'r
SOUTH e:.:.
WIND SOR
Phone
one (860)289-3876 :
Applicant PP scant agree the''t`ri :izrs;fd Q.yr ,4f > rJtit' h Win', '•..; the amount of bond
required and "'%''` '"
4 X .i3rse''tbe T$3ar>::; o t "y3sor : >;':an' "ex "e
incurred b the "`y Town #�,;<aret�[�>��'Sena`3���=::'a�'�<>:r'�'p�ahe'�s:Y�rsrk>�";�a'g* nnect on with this
permit and that
t,&e rules and
c•i:
regulations for permits as`'<:ptj l```ri :d;:F' rk''t'lid: saa>''o"f''"SrUh .,Wind'sor's Stre
et
Cut Pe
rmit
t Manua
l.
* * PERMIT
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Issued by All
Date Completed — Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
R
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
' TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm-_�\` c � �� `�
PhoneNo.Ql ��-��
Address of Firm
Location of proposed work
Describe fully nature of permit requested
Starting date Approx. time for completion_
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
t; `.I c_, No. cuts
Est.Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est. Unit Price$
i
Amt.of Deposit$
Total Due$ by
N
Cash( )Check#
i
F
t� Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
$
Amt. Due Payee
Amt. Due Town
Applicant is responsible for contacting 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 f S OUT4INED THE TOWN Of SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
ter__
S d:'igne // �..�.�( -�/. .f Date: 7
a J
Title: ��� -����.//�/ (� Driver's License#:
PERMITRII�ALL BE KEPT ON JOBSITE AT ALL TIMES