HomeMy WebLinkAboutStreet Cut Permit 140 Farnham Road 1000145 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/10/10 ¢
GIS ID:32100140 FEE: 25.00
MUNIS APPLICATION# 201001021 TION DATE: 08/10/11
APPLICAN = -- OCATION
NAME: AIROLDI'S INC. S. HAM ROAD
ADDRESS: P O BOX 71 " S MELVIN I&GWEN G
SOUTH WINDSOR, e6Oj AM ROAD
PHONE TR SOR,CT 134 2 44
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WORK DESCRIPTION: DRIV .
APPLICANT AGREES TO FURNISH THE TO
ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY Y O MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE I LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SO S RMIT MANUAL
0 Wb 116 U ;62�s
ISSUED BY DATE INSPECTED INSPECTED BY
8/10/20103:42PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
-...---------------------- .......--........ ........- .....-....... - - ---- ------------------------------- ...._------------------....
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TOWN OF SOUTH WINDSOR INSPECTION:REPORT
PERMIT NO.: OD Q NS CONTRACTOR:_,A- i ro ( Gi 1 ' S
LOCATION: q0 �Q(Z N U 1 Q YV 1
TYPE OF WORK:___ _ Dr W-e C�Ct
DATE INSP NEEDED:__' DATE INSP: 9
INSPECTED BY:. al cam__
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED
WITNESSED El YES ❑ NO
AS-BUILT:
INPUT: . C Y
- DATE:
W12007 Town of South Windsor TNPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT A
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm '����- -S �''��' Phone No.
Address of Firm_ -�-�ay. �l\ �o�,�'e.��s ov Zip Code C�bin
Location of proposed work .o
Describe fully nature of permit requested % w �Qw
Starting date \'a. \a Approx.time for completion
Call Before You Dig Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
a Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
0
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 LINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: o
Title: 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