HomeMy WebLinkAboutStreet Cut Permit 90 Scott Drive (2) 900084 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 07/15/09 fm VFW
GIS ID:81600090 �
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FEE:
MUNIS APPLICATION# 200900817 25.00
y� NIRATION DATE: 07/15/10
APPLICAN = LOCATION
NAME: AIROLDI'S INC. " DRIVE
ADDRESS: P O BOX 71 �=
A STEVEN ISSA&PATRICIA W
SOUTH WINDSOR, T0f4 � � SCAT DRIVE
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PHONE — � INDSOR,CT 06074
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WORK DESCRIPTION: DRI a
APPLICANT AGREES TO FURNISH THE TV-OF S4
�O �DND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANt X�I�SEQNC T' tj MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE�PL 1TI .. L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED INTHE TOWN OF SQL JI STI2EITU T` IFMIT MANUAL.
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ISSUED BY DATE INSPE TED INSPECTED BY
7/15/20092:12PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR IN•SPEC'TION REPORT
- - - PERMIT-NO. � -
- CONTRACTOR: ► 12.�1�I 5 .
LOCATION: 9,0
TYPE OF WORK: ����,� -
____..__ .DATE INSP NEEDED:
DATE INSP: /z
INSPECTED BY:
WORK IN
PROGRESS: A
�e t C o6G c .
AS-BUILT: -
DATE:
. 9
W12007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT I 000,Y
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $26.00
Name of Firm '���� Phone No.
Address of Firm
Location of proposed work 0
Describe fully nature of permit requested
Starting date Approx. time for completion
Call Before You Dig No. `�-O�`�`�.goo g '-��, Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
i two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No.cuts
l Est. Size of Perm. Patch(s)
i
Est. Pvt.Thickness in.
1 1--\
Est. Unit Price$
Amt.of Deposit$
Total Due$ by
( ) Cash ( ) Check#
0
i
Permanent Patch
\q No. Cuts
j Size of Patch(s)
Final Billing
$
Amt. Due Payee
$
I
Amt. Due Town
I $
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: ��� `l\
Title: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES