HomeMy WebLinkAboutStreet Cut Permits 14 Hearthstone Drive (2) 1200123 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 07/19/12
GIS ID:41100014
MI_INIS_A_P_P_i_ICA_T_TLIT.T-44 FEE:
EXPIRATION DATE: 07/19/13
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APPLICANT LOCATION
NAME: AIROLDI'S INC. ADDRESS 14 HEARTHSTONE DRIVE
ADDRESS: P 0 BOX 71 - W Ic OHM VIRENDRA K&RAJNI
SOUTH WINDSOR, �T QP4 14 TIEAR HSTONE
PHONE - J$0VM WINDSOR,CT 06074
WORK DESCRIPTION: DRIVEWAY
APPLICANT AGREES TO FURNISH THE TQWI OF SOUTH VINDSORTHE`AMOUIIT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY,EX-PENSE IDE TOWN FOR IYIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH�gIPPLI-C T IS FAMI IAR WISH AND WII L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF Oi7TII WII`I6S-R'"TREE'T.CIIT PEI3MTT MANUAL.
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ISSUED BY DATE INSPECTED INSPECTED BY
7/19/201211:18AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: A , �- 7 ) 1-5
LOCATION: q
TYPE OF WORK:
DATE INSP NEEDED: IJ DATE INSP: ' )31 -13
INSPECTED BY: 9b
WORK IN
PROGRESS: '-� S� „
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES [-] NO
AS-BUILT:
INPUT: ' DATE: ` k s v
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No, TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date; \`� »-
L�/'1l_I Tel-Ll f 1�11'\d/1-G1I_.S A L.G__•
FEE $25.00
Name of Firm ����` 5 �'� • Phone No.
o _ r r1 �o>v� � ,., b�Z� —p Code Address of Firm �� -
Location of proposed work
Describe fully nature of permit requested
Slaning date Approx, time for completion
Call Before You Dig No. Existing Water Supply; ❑ Public Water ❑ Well
Existing Sewage Service; ❑ Public Sewer ❑ Septic
PLEASE NOTE; THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, IN6LUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
I
No. cuts
I
Est. Patch Size(s) sf
i
�I Est. Pvt. Thickness in.
Est. Patch Unit Price$ Isl
Est, Patch Cost$
I
Est, Curb Replacement It
i
. e
Est. Curb Unit Price$ ift
0
Est. Curb Cost$
11
Est. Traffic Unit Cost$ /hr
Est.Traffic Control $
I
Amt. of Deposit$
Total Due $
)Cash ( ) Check#
Applicant is responsible for contacting Paid By
i 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
PERMI UTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed Date:
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