HomeMy WebLinkAboutDriveway Street Cut Permits 33 Niederwer f TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3877
Location Contracor»1kFROELDz.. S INC.
Type Work EWAY A Ad 'res :> ;y.•;P 0pX 71"+ .,
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Permit No. 3877 Town of South Windsor, CT
Date 10/28/2004 ».> :• Street Excavation Permit
Expiration Date 10/28/2005
Descrip:
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Name AIROLDI'S INC. q !a' N'IhDERWI RFER ,ROAD
Addr. P O BOX 71 %''
SOUTH WINDSOR CT 06t774 A ��e
Phone (860)289-3876
. : : . heaAPPlicant a r �? h' r moznt of bond
required and to reimbkrs <€ :; ti or ft— ,;;lily Alpghses
incurred by the Town for tt1a:jU narie ,ar p a r Nk n pl�hectiOn with this
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permit and that applicant :0 kythe rules and
regulations for permir-s as biAt'7 `ft Y;: '' ` ' 5'tio i;arf""So"4 .ki' [;ind .:ii: s Street
Cut Permit Manual.
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* * PERMIT TO"'aa"EI'TC<.:k5 ::`A. L`:,T:IINEb`
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT /)I
TOWN HALL S
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm ` Phone No. L0
Address of Firm
Location of propos work
Describe fully nature of permit requeste ` !
Starting date 1 IN i -, Approx.time for completion
Call Before You Dig No.QS-:IQ�� Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing --
,r� Pavement ut
Indicate North �c- Prop. size of cut
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No. cuts
I y� Amt. of Deposit$ b
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Q O Cash O Check#
Cut size after Perm. Patch
] No. Cuts
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'' Final Billing$
L--- I 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.
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Signed: \" t , ��. Date: t
Title: D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavabon Permit.doc