HomeMy WebLinkAboutStreet Cut Permits 32 Brian Road (2) 1400069 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 04/21/2014 =
GIS ID: 13500032 FEE: 25.00
MUNIS APPLICATION# 201400392 EXPIRATION DATE: 04/21/2015
APPLICAII LOCATION
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NAME: AIROLDIS INC DDRE'&S: 132—hR AN ROAD
ADDRESS: BOX 71 MA &LEIGH W&MARTHA M
S WINDSOR, CT 060'14m-3071 3 BRIAN ROAD
S�T�TH'WINDSOR,CT 06074
PHONE
WORK DESCRIPTION: AW
DRIVEVt '
THE DRAIN LAYER ASSIGNED TO THIS P$I 1YI11 HAS A V WD LICEN - ISSLTEI�_BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTI IN TH> ATTACHED3NDITIOI�IS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDA1U5S ALL R OSHA EQUIREMENTS,AND THE ATTACHED CONDITIONS.
ISSUED BY DATE SPECTED INSPECTED BY
4/21/2014 11:34 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /�I� �9 CONTRACTORA 1 r®Idf 'J
LOCATION: IL or
TYPE OF WORK: 1b. r't\�cQaU
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: PP
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
W12007 Town of South Windsor INPSECTION REPORT 07
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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 $25.00
Name of Firm o��` s N Phone No. -3� b
Address of Firm '•� o`e `r Zip ode
Location of proposed work
Describe fully nature of permit requested ,^�J�
S I a n i n 9 dale Approx. time for completion
Call Before You Dig No. �n��\����`3� Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, IN6LUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Snow sketch of proposed work or furnish This s2ctl2n to be filled out by
!wo copies of separate drawing Indicate North Town of South Windsor
No. cuts
Est. Patch Size(s) sf
Est. Pvt, Thickness in.
Est. Patch Unit Price$ isf
Est. Patch Cost$
Est. Curb Replacement It
Est. Curb Unit Price $ /h
Est. Curb Cost$
Est, Traffic Unit Cost$ rhr
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
PERMI�INED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: >�42 \��
T,tie QY--- - Driver's license a:
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
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