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HomeMy WebLinkAboutStreet Cut Permit 2849 Ellington Road 1000210 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER _ STREET CUT PERMIT DATE: 09/28/10 _ „ GIS ID: 30302849 FEE: 25.00 MUNIS APPLICATION# 201001327 � NO �IRATION DATE: 09/28/11 i s APPLICAN of of 'K��� E LOCATION NAME: AIROLDI S INC. RE� 2ELLINGTON ROAD ADDRESS: P O BOX 71 TDE REAL ESTATE INVESTORS SOUTH WINDSOR drubt i � h DR y 4JJ WINDSOR,CT 06074 PHONE c WORK DESCRIPTION: DRI� st ENT CE( N APPLICANT AGREES TO FURNISH THE T VJ� P O JTFI A '1,OMB-G REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH WINDSOR FOR ANIIFT�VVI AINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND THE AM IARA > .L ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN O IT MANUAL. fro �© ISSUED BY DATE INSPECTED INSPECTED BY 9/28/201011:32AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** - - .. --_..................... -----...------------------------- __------ ------- ................ -- .............. -------.... -------------------------------------............-------------------------------------------------------...-------------------------------------------- fa Za AWAu Ax y A Awd mud 46 TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: Z 000a 10 CONTRACTOR: K, rot od ► I S LOCATION: a 84 9 (l e-6 _0n TYPE OF WORK: 'br\ DATE INSP NEEDED: DATE INSP: 13 1) INSPECTED BY: WORK IN PROGRESS: L a bl s SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO AS-BUILT: INPUT: Gw� DATE: S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION APPLICATION FOR STREET EXCAVATION PERMIT /900a/(�) TOWN OF SOUTH WINDSOR Permit No. PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074 FEE $25.00 Name of Firm "' ` S �j--t`' C Phone No. Address of Firm .o Qo `1\ Its C 11 O 6IzC-1 Location of proposed work Z _ Y1 Describe fully nature of permit requested G- Starting date d Approx.time for completion Call Before You Dig No. m Traffic Services Control No. Show sketch of proposed work or famish This section to be filled out by two copies of separate drawing Indicate North Town of South Windsor Pavement Cut No.cuts Est.Size of Perm.Patch(s) Est.Pvt.Thickness in. Est.Unit Price$ Amt.of Deposit$ �y C` Total Due$ by "YY C) )Cash( )Check# f- T Permanent Patch No. Cuts a�- Size of Patch(s) <— �'J t Final Billing \ Amt.Due Payee Amt.Due Town By Applicant is responsible for contacting Date the Police Dept.and C.B.Y.D. 1 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 1 AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLLED N H T WN OF SOUTH WINDSOR'S STREET CUT PERMIT MAN An Sign71 ed: Date: �& Title: — - Driver's License# _ PFRIIAIT SNAI I RF KFPT nN InRCITF AT Al 1 TIRR=Q