HomeMy WebLinkAboutStreet Cut Permit 905 Pleasant Valley Ro 900138 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 10/13/09p
GIS ID: 72900905 ''
MUNIS APPLICATION# 200901243 '' ate' w: •;. FEE: 25.00
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3 . ;. ATE: 10/13/10
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APPLICAl 'T
OCATION
.NAME: AIROLDI'S INC.
ADDRESS: P O BOX 71 '4 FAISANT VALLEY ROAD
SOUTH WINDSOR, TITI RAYMOND A&
yv .
�b(7 PTAANT VALLEY
PHONE ' ->.u3 � . t? WINDSOR,CT 06074
WORK DESCRIPTION:
APPLICANT AGREES TO FURNISH THE T
REQUIRED UIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FORA ,:> A Q
I LTG, l wQ4 FOIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE •.Ix�� " T,YS' r.'. "'>� •
y �W"LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S� T1i'
�WoPErtMITMANUAL.
ISSUED BY DATE INS ECTED INSPECTED BY
10/13/200911:22AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 9 oa CONTRACTOR: �L '-s
LOCATION: 905
Plea a,nt ijo 11p�i -RI)O A
TYPE OF WORK: r a,
DATE INSP NEEDED: DATE INSP: l 2 y
INSPECTED BY:
WORK IN
PROGRESS: Zid s
A_)o S�
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: � DATE: C�"
W/2007 Town of South Windsor INPSECTION REPORT 07
0020/c) V3 APPLICATION FOR STREET EXCAVATION PERMIT ` ee2/3 g
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT G
1540 SULLIVAN AVENUE Date: 00(
SOUTH WINDSOR,CT 06074
FEE $25.00 2
Name of Firm TPhone No.30
Address of Firm 0 o Zip Code CQ04—
Location of proposed work
Describe fully nature of permit requested
Starting date--t O Approx.time for completion d
Call Before You Dig No. `ate®� -®b�.��� Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or fumish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
0
Est. Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
y
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
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
PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT p( ` PER IT MANUAL.
1� ,
Signed: r Date: �0 �61
Title: rllpJ Driver's License#:
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OF PERMIT
WORK MAY NOT BEGIN UNTIL A PERMIT HAS BEEN ISSUED
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08 REV 10-22-08