HomeMy WebLinkAboutStreet Cut Permits 130 Kent Lane 1300062 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 04/23/2013
GIS ID: 50100130 - FEE: 25.00
MUNIS APPLICATION# 201300492 Aff ! I PIRATION DATE: 04/23/2014
APPLICANT
�� LOCATION
NAME: AIROLDI'S INC. DRE30ET LANE
ADDRESS: P O BOX 71 �� jam'
R13E L MARK K&MARGARET M
SOUTH WINDSOR, T04
_ 10 -KEIT LANE
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PHONE � = t INDSOR,CT 06074
WORK DESCRIPTION: DRIP
APPLICANT AGREES TO FURNISH THE" WWP SOUTI�
�� �1; M4 T OVA ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN'�EEN3S I1GrI
� T �NOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THILA1�15A V�T1�4 W L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF �IT WI15�I�y1F��PIIT MANUAL.
ISSUED 13Y DATCTED INSPECTED BY
4/23/20I38:23AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:
CONTRACTOR: /l�d)d/
LOCATION: e n-t-
TYPE OF WORK:
DATE INSP NEEDED: ®ATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:_ 6_�_e l+n 5ig,
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 $25.00
Name of Firm "� 3 - Phone No.
Address of Firm `� -` 5 r_ `l\ ����� -�� 5��� C Zip Code
Location of proposed work �-
Describe fully nature of permit requested
Starting dates `3 Approx. time for completion
Existing Water Supply: ❑ Public Water ❑ Well
Call Before You Dig N0.
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
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No. cuts
Est. Patch Size(s) sf I ,
Est. Pvt. Thickness in.
ly
Est. Patch Unit Price$ ,-sf
Est. Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
Est. Curb Cost$
Est. Traffic Unit Cost$ ihr
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 �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
S:reei Excavation Permit 08 REV 10-22-08