HomeMy WebLinkAboutDriveway Street Cut Permits 64 Birch Hil 80412 TOWN OF SOUTH WINDSOR, CT
" PERMIT NUMBER
STREET CUT PERMIT
DATE: 07/10/08
:
GIS ID: 11400064
MUMS APPLICATION# 200801038 FEE: 25.00
EIItATION DATE:
07/10/09
APPLICANT � s LOCATION
NAME: AIROLDI'S INC. °>• .....<; >s; x
ADDRESS: P O BOX 71135 BIII'HILL DRIVE
SOUTH W
tE) VAK 1
WINDSOR OBERT S&PATRICIA T`'
!'. R< I<IILL DRIVE
PHONE
:
' S [fiTH WNDSOR,CT 06074
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SCRIPTION:
SC RI PT IO N:
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APP
LICANT
CA NT AG
REES
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TISq T 1MOUNT t?I BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANI''FXPI�IES II*IC, $ PFII IOWI+#:'XplOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE tP LICANT I.S"IAA ;: VI I II: 4ITLj>V�zp L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN
O S( TI : 1 I ' TR P,CJT IT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
7/10/20088:48AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: goo I I CONTRACTOR:. A V0 ) S
LOCATION: I_
'TYPE OF WORK: �}
DATE INSP NEEDED: DATE INSP: /CY
INSPECTED BY:_ >
WORK IN
PROGRESS:
AS-BUILT:
INPUT:_ DATE:_
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT '3
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm ''Nt j �'�" Phone No.
Address of Firm _c� o `"1\ av�. CT.So� C`' U
Location of proposed work
Describe fully nature of permit requested
Starting date Approx. time for completion
Call Before You Dig No. o(Z:5 -8 Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
iNo. cuts
Est. Size of Perm. Patch(s)
i
3s Est. Pvt. Thickness in.
i
i
Est. Unit Price$
Amt. of Deposit$
Total Due$ by
I
( ) Cash( )Check#
\� Permanent Patch
No. Cuts
i
6 Size of Patch(s)
i
I Final Billing
> $
\o
Amt. Due Payee
i
\C� —� 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
PERMIT UTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES