HomeMy WebLinkAboutStreet Cut Permits 26 Ellsworth Circle (2) --
1300250 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/04/2013 % , vill ,
GIS ID: 30500026
MUNIS APPLICATION# 2013014 FEE: 25.00
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- �' 'IRATION DATE: 10/04/2014
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APPLICANT ,� v LOCATION
NAME: AIROLDI'S INC. REST A EtLS�JORTH CIRCLE
ADDRESS: P O BOX 71 j JRPHIV DENNIS J&DEBORAH J
SOUTH WINDSOR;G �4
„ I✓ SVORTH CIRCLE
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PHONE - � JVINDSOR,CT 06074
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�VICE
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WORK DESCRIPTION: DRIB
APPLICANT AGREES TO FURNISH THE V(9WfitlSdVTI4 AM ( $4 1D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANII'EISET � � �Lu �RAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI �, 'IAA = A W1 ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF QQ 'ffy IIS 1 1�,P T MANUAL.
ISSUED BY D T ACTED INSPECTED BY
10/4/2013 10:10 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
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PERMIT NO.:_Z&D_d� CONTRACTOR:
LOCATION: a(n F l t �S W& rG
TYPE OF WORK:_DY \\3-2 Lou<P
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: �
WORK IN
PROGRESS: o_ !�
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: 3.17'
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT 1�n
1540 SULLIVAN AVENUE Dater aG�3
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of FInn%`c Phone No ®
Address of Firm Zip Code
Location of proposed wo G
.,Describe fully nature.of permit requested
Starting date\ aG� Approx.time for com tion 3
Call Before,You,Dig No: O Existing Water Supply: ublic Water ❑Well
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Existing Sewage Service: tq Public Server ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT;INCLUDING ANY INCREASES IN PATCH AREA,CURB.
.'LENGTH,TRAFFIC;CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH.IS TYPICALLY
COMPLETED WITHIN AYEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
-Show sketch of proposed work or furnish This sadton to be filled out by
two cries of separate drawing - 1ncricate.North Town of south Windsor
No.cuts
— -- - - - —� Est.Patch Sizes) if
Est,Pvt.Thickness in.
Est.Patch Urvt Prices 1sf
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fr .✓ a6��sWa'�. Est.Patch Cost s
Est.Curb Replacement ft
Est.Curb Unit Price At
Est.Curb Costs
Est..Traffic Unit Cost$ Ihr
Est:Traffic Control s
Amt.of Deposit$
... ,...- Total Due s
1vw�e L
O Cash O check#
Applica
Paid By
the.Rolice De t.and G.B:Y.O.
I AGREE TO FURNISH TO.THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
IM
TOWN OF SOUTH.WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN.FOR.MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PESMIT AND THAT I AM FAMIIJAR:WITH.AND WILL ABIDE BY THE..RULES AND REGULATIONS FOR.
PERM $O N D IN THE tOWN OF SOUTH WIND80 S STREET CUT PERMIT MANUAL.
Signed: Dater h \'�
Titter 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