HomeMy WebLinkAboutStreet Cut Permit 30 Valley View Drive 900071 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/29/09 ,, "
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GIS ID: 91200030 � ,�`°°� •`••f ` � �` ° FEE: 25.00
CATION# 2 0725
MUNIS APPLI 0090 TION DATE:
06/29/10
APPLICANfi h aI OCATION
NAME: AIROLDI'S INC. '`` xVA , Y VIEW DRIVE
ADDRESS: P O BOX 71 1 `
I MIDAS DEAN H&DONNA P
SOUTH WINDSOR Ib7 ""
' 4MY VIEW DR
' ` TE WNDSOR,CT 06074
PHONE ,
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WORK DESCRIPTION: DRI )
APPLICANT AGREES TO FURNISH THE TbV&.IbF 5� JNT M B&D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN ' " ` D Q
� �. ? ., OVFT O >vIAINTENANCE OR REPAIR WORK IN
is )... t ) :t.n.. F. y�
CONNECTION WITH THIS PERMIT AND THE` PlL T IS W. I aND , LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OFStTT �5 S IT MANUAL.
ISSUED BY DATE INSPE TED INSPECTED BY
6/29/200910:34AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOa INSPECTION REPORT
PERMIT*NO.: 9 000 7 1
CONTRACTOR: .(
LOCATION: \)a )
TYPE OF WORK: kPe u.-
..DATE INSP NEEDED:
DATE INSP:
- _ INSPECTED BY:
WORK TN
PROGRESS:_ o
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AS-BUILT:
INPUT: C V' DATE: 1
W/2007 Town of South Windsor INPSEC ION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT 900,5p 7/
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm �,.���:- s yN c. . Phone No.
Address of Firm
Location of proposed work `__ztS o
Describe fully nature of permit requested
Starting date Approx. time for completion r-t)-wAX\4
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No.cuts
Est. Size of Perm. Patch(s)
ag Est. Pvt.Thickness in.
Est. Unit Price$
3 t Amt.of Deposit$
e
Total Due$ by
Cash( )Check#
Permanent Patch
No. Cuts
F V) 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 TLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
T
Title: Q,�N Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES