HomeMy WebLinkAboutStreet Cut Permit 10 Hayes Road 800058 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBERk. STREET CUT PERMIT
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DATE: 05/02/08
GIS ID:40200010 f :y.>
MUNIS APPLICATION# 2008005 13 � ' `' £: FEE: 02/00
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APPLICA: �N" ��. �.. '� �' :�. �.�.�w�...� <.
OCATION
NAME: AIROLDI'S INC. �" y�0 g7ZOAD
ADDRESS: P 0 BOX 71
S SANDRA M&ALAN E
SOUTH WINDSOROAD
... .. s. V4�ITDSOR,CT 06074-278
PHONEo
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WORK DESCRIPTION: DRIV ' y
APPLICANT AGREES TO FURNISH THE TORSI S kh ,SSS T BC? ID REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY O.. � E11 ?R AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THEI TI`S ` IiD ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF,' �z.. : I IMP IT MANUAL.
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ISSUED BY DA E MPECTED INSPECTED BY
5/2/200811:21AM *** PERMIT TO BE KEPT ON JOBS I TE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: ncosw CONTRACTOR:_-A (e)
LOCATION: I I�tQS D�
TYPE OF WORK: (A)
DATE INSP NEEDED: DATE INSP:_ 0lZ, 0y
INSPECTED BY: 81
WORK IN
PROGRESS: Z_��k
O S a _101 .
AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION 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 $25.00
Name of Firm Phone No.
Address of Firm CT
Location of proposed work
Describe fully nature of permit requested
Starting date Approx. time for completion
Call Before You Dig No. `�oog \`-pc)\003 Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No. cuts
Est. Size of Perm. Patch(s)
Est. Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$
0
is \o" —�
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
91 Size of Patch(s)
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
PERMI OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: \dam
Title: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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