HomeMy WebLinkAboutStreet Cut Permits 8 Kellog Circle (2) 1500057
TOWN OF SOUTH WINDSOR, CT
PENT NUMBER STREET CUT PERMIT
DATE: 05/05/2015
GIS ID: 49400008 FEE: 25.00
MUNIS APPLICATION# 201500446 EXPIRATION DATE: 05/04/2016
APPLICANT; LOCATION
NAME: AIROLDI'S INC. ADDRESS: 8 KELLOG CIRCLE
ADDRESS: P 0 BOX 71 = OWNER: LIN XIA14HUI&
SOUTH WINDSOR, CT 06074 8 KEI LOCI CIRCLE
SOUTH--) INDSOR,CT 06074
PHONE
WORK DESCRIPTION: DRIVEWAY
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE
ICENSE IS
SUED BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH-IN THE ATTACHED`CONDITIONS'. ALL WO1K SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
5/5/2015 8:54 AM ISSUED DATE INSPECTED INSPECTED BY
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: f 3��� 7 CONTRACTOR:
LOCATION: 0 L� /alto
TYPE OF WORK: Il)a �9
DATE INSP NEEDED: DATE INSP: s/atilia
INSPECTED BY:
WORK IN
PROGRESS: c
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ o DATE:
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
\ _ TOWN HALL 1640 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00
Name of Firm
C\'i•� ;. S �S� - Phone No. �0\`�8`�- 3g`1 L
Address of Firm_ -O , `1 \ ate` J,`� sbv Zip Code
Location of proposed work
Describe fully nature of permit requested
Starting date Call Before You Dig Now\�\ '� 7
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
C�jP �as � Est. Patch Size(s) sf
^� Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
3ta Est. Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
�, Est.Sidewalk Replacement sf
Est. Sidewalk Unit Price$ /sf
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting the Police Dept:and C.B.Y.D
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Paid By
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 ILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDSO STR CUT PERMIT MANUAL. \
C \\�� . ��h�.a I+ l
Signed: Print Name Date:
Street Excavation Permit 2014