HomeMy WebLinkAboutDriveway Street Cut Permits 426 Barber H PEPERMITRMIT NUMBER TOWN OF SOUTH WINDSOR, CT
STREET CUT PERMIT
DATE: pig
GIS ID: 07800426
MUNIS APPLICATION ,,+`w ' FEE
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# 200801684 25.00
' 33;RATIO
N DATE: 10/28/09
APPLICANT
NAME: AIROLDIS INC. r 'Y; 'y,: K :k.. _.r ; LOCATION
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ADDRESS: P O BOX 71 f ' 'f r ' � . ' 426 BARBER HILL ROAD
RI1TAGE HILLS LLC
SOUTH WINDSOR,CTb074r� :N
+rk�i 3 x C °46 `R11GE;i`D
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PHONE frOt7TH WdNDSOR�CT 06074
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WORK DESCRIPTION: DRIWtiY
APPLICANT AGREES TO FURNISH THE TC1: 'OF ROUT '
THE TOWN OF SOUTH WINDSOR FOR ANY'EXP I P :. rC i? ��II1 ND REQUIRED AND TO REIMBURSE
CONNECTION WITH THIS PERMIT AND THE' P-d"ANT IB IAR �VITTO j FORMAINTENANCE OR REPAIR WORK IN
FOR PERMITS AS OUTLINED IN THE TOWN OF SLJTP.; V 1?VILL ABIDE BY THE RULES AND REGULATIONS
v T tictjT I2MIT MANUAL. \
""" L''•'<� ,;.�. sown:';;iF::or,'^<x':. - 1,
IS ED DATE WINSPECTED
INSPECTED BY
10/28/20081:46PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: OD ( CONTRACTOR: - I ro
LOCATION:
Al
TYPE OF WORK: r
--_-_- -DATE INSP NEEDED: DATE INSP: /09
INSPECTED BY:
WORK IN
PROGRESS:_
AS-BUILT:
INPUT: DATE:_-
W/M Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT.
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
\ FEE $25.00
Name of Firm
cam, —� Phone No. �`�C1 3�
�� o � �� �--�''c-
Address of Firm
Location of proposed work
Describe fully nature of permit requested \ \
Starting date \� ` � Approx. time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish Indicate North This section to be filled out by
two copies of separate drawing Town of South Windsor
Pavement Cut
No. cuts
4 , 0 Est. Size of Perm. Patch(s)
3 Est. Pvt. Thickness in.
Est. Unit Price$
Amt.of Deposit$
1
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
�83
Final Billing
$
Amt. Due Payee
V.0 $
v 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 TLINED IN THE TOWN OF STREET CUT PERMIT MANUAL.
Signed: SOUTH�WINDSOR'SDate:
Title. Gm Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES