HomeMy WebLinkAboutStreet Cut Permit 185 West Road 1000050
PERMIT NUMBER TOWN OF SOUTH WINDSOR, CT
STREET CUT
DATE: 04/05/10 7 " PERMIT
GIS ID: 93600185 _ _�_ _ If
MUNIS APPLICATION# 201000328 f �/
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FEE: 25.00
E ATION DATE:
�% 04/05/11
APPLICAN s
AIROLDIS INC y, O
� CATION
NAME:
ADDRESS: PO BOX 71 $ TROAD
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S WINDSOR,CT 060'AQ1 �t NTNI CRAIG E&LORI L
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PHONE i BROAD
O TT-H VW[NDSOR, CT 06074
WORK DESCRIPTION: y �� s
REMOANb
APPLICANT AGREES TO FURNISH THE TOE �%� /
THE TOWN OF SOUTH WINDSOR FOR A /
E M F WEND REQUIRED AND TO REIMBURSE
CONNECTION WITH THIS PERMIT AND THE B� O MAINTENANCE OR REPAIR WORK IN
THE TO
WT1� ILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE OF SO WIIiTPU� RMIT MANUAL.
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ISSUED By � DATE INSPECTED
4/5/2010 11:17 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** INSPECTED BY
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: l 0000SO CONTRACTOR:
LOCATION:
TYPE OF WORK: .0.U
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: �)
WORK IN
PROGRESS: D6
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: I
W12007 Town of South Windsor INPSECiION REPORT 07
gwobL8a APPLICATION FOR STREET EXCAVATION PERMIT locboso
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm MI;L�.� Phone No. 3G6 3-13
Address of Firm . 0 c r Zip Code O Ca 7
Location of proposed work
Describe fully nature of permit requested
Starting date d Approx.time for completion
Call Before You Dig No.- C,1Q 13 0 -SO Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or fumish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est.Patch Sizes) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est.Patch Cost$
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 (v f Check#A 0 T
Applicant is responsible for contacting Paid By
the Police Dept.and C.B.Y.D.
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 OUTLINEDIN THE TOWN QF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: I��J/ Date: G
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