HomeMy WebLinkAboutDriveway Street Cut Permits 104 Norton L TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 4066 Contx:ad or AIROLYINC.
Location 0104 HORTON LANE Rd'dress, €;`:;:'<P O.;'B{)X;^<71 '""
Type Work DRIVEWAY
SOUTH ➢7TNE)�OIZ. CT 06074
Phony Igo (8.gb4289 38.76
Date Insp Needed bt,
Time Insp Needed
Inspected By
Work in Progress 4J�
Input ---......._
Permit No. 4066 Town of South Windsor, CT
Date 08/23/2005 Street Excavation Permit
Expiration Date 08/23/2006
Descrip:
Applicant hocat3dn
Name AIROLDI'S INC. O104 .DTORTON LANE.,:
Addr. P O BOX 71
SOUTH WINDSOR CT -6074 rf Crf Work DRIVEC^I Y
Phone (860)289-3876
Applicant agrees: to ft1n1S1x thep4W3i �ipLth, Windsdr'. the .amatrnt of bond
required and to reiCnburs� '�he'.Tow oCkt :Wp, fd 'ate, cpenses
incurred by the Town fdr riax3t�nance or repair workn e'onnction with this
permit and that applicant stililx ? 3 W �'1 &bi 'tke rules and
regulations for permits as, dEitlined an t1i Tows of Sou Wxidor's Street
Cut Permit Manual.
* * PERMIT TO"'BE 'k�P.T
Vt� l l
Issued by
_Date Completed _----_---- Inspected By
APPLICATION FOR STREET EXCAVATION PERMITC�' C�
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm`C����` ���' ��� Phone No.
Address of Firm '"� . C`)
Location of proposed work ��
Describe fully nature of permit requested
Starting date �� '� (1� Approx. time for completion 1
Call Before You Dig Na � Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No.cuts
0 Est. Size of Perm. Patch(s)
Est. Pvt.Thickness in.
a Est. Unit Price$
)(} � Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
t - — Final Billing
$
Amt. Due Payee
Amt. Due Town
By
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
PE TS A OUTLINED IN T TOWN OF SOUTH WINDSOR'S STREE T PERMIT MANUQL..
Signed: S`�J►� �`� � y-t
r
D te:
Title: Driver's Lie e#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES