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HomeMy WebLinkAboutDriveway Street Cut Permits 199 Troy Roa s � TOWN OF SOUTH WINDSOR INSPECTION REPORT Permit No. 3876 Cont zc•Cti 'A'fItT7TDI!. INC. Location TOY Pdi'1re S g.:f P 0 OX,<.:..7,1. <.. Type Work DRIVEWAY <, $ S-01 H W;'lNP�`OR 06074 Date Insp Needed �h Time Ins Needed P d Inspected e cte d By ^�Y,.3n. "vX in Pr Wo rk 0 .:� 9r ess 'b A?< f:rn: jiff.:>.e A ; N a ti Permit No. 3876 Town of South Windsor, CT Date 10/28/2004 Street Excavation Permit y Expiration Date 10/28/2005Descri ;s ' P' z Applicant ova.; PP sr:. 'a:I. ti .n z: Name AIROLDI'S INC. .r Addr.. P O BOX 71 : SOUTH WINDSOR C: BR'T..PrIAY ss;.:<z:: Phone 860 28 -( ) 9 3876 Applicant agrees to` fuxn ah''the Tow �f S��eb3� WindsO� 71 the anoint of bond required and to reitnb;E:��se..,:: ie & uh:< :nr fsr';.;;azi•`y ::ex:.p eases . incurred b the Towl: f.a: r�ia; tnan '«'�yr''" '` • r`:%0k..: ne'Y with this permit and that a 1 ' P PP .oa '< s''., m •1<a:a :< i<:":'.., x >21''' YS` cx s; Elie rules and , y �3: € :.,Y. regulations for ermits as ©:�t'l.ii4a—"S "�h'e"s a .a:: f'""Sd .ti nd `br' Street g P ;?hF. s s t eet Cut Permit Manual. t * PERMIT Tn rICP ..O'I3..::7f}$?' I.7F=;>.AT' Al Issued by Date Completed ...... Inspected By � �=� � APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL J S 7 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Fi ` Phone No. Address of Firm Location of propos work Describe fully nature of permit request Starting date _ Approx.time for completion Call Before You Dig N Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town of South Windsor two copies of separate drawing Pavement Cut Indicate North Prop. size of cut No.cuts Amt.of Deposit$ by U -'—� ()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. 1 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 S UTH WINDSOR'S STREET CUT PERMIT MANUAL. Signed* v /y Date. Title D.L.# PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES Standard Forms\Permits\Street Excavation Permit.doc