HomeMy WebLinkAboutStreet Cut Permits 169 Benedict Drive (2) 1300144 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/25/2013
GIS ID: 09600169 FEE:
MUNIS APPLICATION# 201300869 - - EXPIRATION DATE: 06/25/20104
APPLICANT
NAME: AIROLDI'S INC. LOCATION
DRE r6q;BEI DICT DRIVE
ADDRESS: P O BOX 71 �l �_!�"
EIS MAIO 1OHN P&LORAINE C
SOUTH WINDSOR, I76 NDICT DRIVE
PHONE
%` fAffff bTH- INDSOR, CT 06074
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WORK DESCRIPTION: DRIVE %i% � W. J -
APPLICANT AGREES TO FURNISH THE T Wg' I OUTI D
-WO 0-f CAP 134ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANC EI' I S 1JCE 1HE TOWN �R MAINTENANCE OR REPAIR WORK IN
AW
CONNECTION WITH THIS PERMIT AND TI-19AFOLIO�ANT1S W-H A j W� ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN^ U`TI WI SR A REfj- UT P-E MANUAL.
ISSUED BY DATE IN8PtCTED INSPECTED BY
6/25/2013 11:02 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I no j CONTRACTOR: &Yrdloll 's
LOCATION: I_C� GPlG41
TYPE OF WORK: !�-L
DATE INSP NEEDED: DATE INSP: -f
INSPECTED BY.
WORK IN
PROGRESS:
L�
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT.
INPUT: DATE:
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.
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm Phone No.
Address of Firm Zip CodeMm
Location of proposed work
De cribely n �C�e�of,permit requested
'`��
Starting date Approx.time for completion ill
Call Before.You Dig No: Existing Water Supply: Public Water Well
Existing Sewage Service: 0 Public Sewer D Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST_ OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWITS CONTRACT COSTS. THE PERMANENT.PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
.Show sketch of proposed work or furnish This sw out by
two copies of separate drawing Indwate:North Town.of Sdi th Windsor
t 1 No.cuts
C \ S Est.Patch Size(s) sf
Est.Pvt.Thidmess in.
Y
Est.Patch Unit Price
1
Est.Patch Cost i
CS
n t;,� t Est.Curb Repiacemerrt ft
;'`',� Est.Curb Unit Price$ xt
Est.Curb Costs
Est..Traffic Unit Cost$ Mr
Est Traffic Control S
Amt.of Deposit$
<'-'`C31 e...., Total Due$
Cash O Check#
Applicant is responsible for contacting Paid By
the Police De t.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 SO H.WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONN ION THIS PERMIT AND THAT(AM FAMILIAR WITH AND WILL.ABIDE BY THE RULES.AND REGULATIONS FOR.
PERMI S E THE TOWN OF SOUTH WINDSOR'S STFIEET CUT PERMIT MANUAL.
Signed: Date:C 44 ;IZA3
Title: Driver's License#.0AZ& `11S
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OF PERMIT
WORK MAY NOT BEGIN UNTIL A PERMIT HAS BEEN ISSUED
PERMIT$HALL BE KEPT ON JOBSITE AT ALL TIMES
sbeet'-Excmt4on Permit 08 REV 10-22-08