HomeMy WebLinkAboutStreet Cut Permits 78 Natsisky Farm Road (2) 1100155 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/03/11
GIS ID: 62300078 = FEE: 25.00
MUNIS APPLICATION# 201101158 EXPIRATION DATE: 10/02/12
APPLICANT ,. - LOCATION
NAME: PALAZZO CONSTRUCTION, C ADDRESS; 7$NATSISKY FARM ROAD
ADDRESS: 150 DIVIDEND RD OW1tER DFFLEY TIMOTHY J&BETSEY S
ROCKY HILL,CT 06067-,- = = 78 XATSISKY FARM RO
- OJTH W INDSOR,CT 06074
PHONE 860-563-6468 Z - _
WORK DESCRIPTION: DRIVW2�Y
APPLICANT AGREES TO FURNISH THE TflW�I OF SOUTH WII#D§OR HE AMOK- OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANI'EPIrNSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE :i4-4CANT IS FAMILIAR WITH AND WII L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSR'S STRE T CLJT PERMIT MANUAL.
ISSUED BY-
_j DATE INSPECTED INSPECTED BY
10/3/201112:OOPM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
......- -- - --
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT'NO.: I CONTRACTOR: p0'ljAZl-K5 ---c0—r)5fK
LOCATION: ' ,rt2 M
'TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: io a7 ii
INSPECTED BY:__ S D
WORK IN
PROGRESS: r�, �� .
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
'AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSEC HON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT //Do/.ss—
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: 4 9 v
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm Poi ciz-Z-0. 9'. c R Phone No...A6a `"&168
Address of Firm r GIc W 'l Zip Code 060-rs?
Location of proposed work ""
Describe fully nature of permit requested
4 �IYe-67�
Starting date /o 13 lr rox.time for completion
Cali Before You Dig.No. 011�?of j, 3 Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH:AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST.OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
-LENGTH,TRAFFIC CONTROL AND-THE TOWNS CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR. -
Show sketch of proposed work or fumish This section to be filled out by
two copies of separate drawing Incficate.North Town of-South Windsor
79cif No.cuts
�7
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ !sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /tt
-Est.Curb Cost$
Est.Traffic Unit.Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
O Cash ( )Check#
Applicant is responsible for contacting Paid By
the Polioe 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 U NED IN TH WN OF SOUTH WINDSOWS STREET CUT PE MIT tAAN UAL.
Signed• , Date: WAVII
Title: Driver's License#. i 5_3
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 ESccavatlon Permit 08 REV 10-22-08