HomeMy WebLinkAboutDriveway Street Cut Permits 74 Pine Tree TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No 3765,
Location
. r,. Contractor AIROTVyT..$, INC.
Type Work ', ry F1 dress, ,<P O 80 :;.71
SOUTH W'TNDSOR CT 06074
Phorke No ($ ,0`)2$9-38.76
Date Insp Needed
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Time Insp Needed
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Inspected By — —
Work in Progress C o 1C
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Input Date ���-
Permit No. 3765 Town of South Windsor, CT
Date 06/17/2004 Street Excavation Permit
Expiration Date 06/17/2005
Descrip:
Applicant ;aLocatcrn
Name AIROLDI'S INC. 3.
0074. PINE TRSE-.LAk.
Addr. P 0 BOX 71
SOUTH WINDSOR Cfi Of 0 74 Type o£ FXor1� .�3R�V$i71Y.
Phone (860)289-3876
Applicant agrees; to furnish',"the Town of S:P"UCh Windsor the: ptotixnt of bond
required and to re mbtiir'se .he OWX7 0 soubh W d o fop any `exp(onses
incurred by the Town fo ma`
a#t'enano'e 'or r pair'wor:xik InrCoiin .cti;on with this
permit and that applicant is fam7li tkz szd will abide,by the rules and
regulations for permits as ouG fined Che.2oAi:.of S0aEh,Wjn ,Oor's Street
Cut Permit Manual.
* * PERMIT TO TI
BE FCEP� O14"c7OB SITE AT„AIL MES.
Issued by __ l✓ ' I ____ itla
Date Completed Inspected By � "
i
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firmer >� �5 �� Phone No - .�
Address of Firn
Location of propose work_ —`
Describe fully nature of permit reque ed
Starting date S Approx.time for completionRE17
Call Before You Dig Now 1 �Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North 1 Prop. size of cut
No. cuts
Amt. of Deposit$ by
i ( )Cash ( )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.
Si ned:
9 Date:
Title:- D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc