HomeMy WebLinkAboutStreet Cut Permits 678 Avery Street (2) 1500105 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/09/2015
GIS ID: 06300678 FEE: 25.00
MUNIS APPLICATION# 201500677 EXPIRATION DATE: 06/08/2016
APPLICANT ;= LOCATION
NAME: AIROLDI'S INC. ADDRESS: 678 Ali ICY STREET
ADDRESS: P O BOX 71 -OWNER: BIRCH JMES C&SUSAN
SOUTH WINDSOR, CT 06074
678 ABRY ST
SOUTH WNDSOR, CT 06074
PHONE `
WORK DESCRIPTION: DRIVEWAY"
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WIN b OR 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 THE APPLICANT IS FAMILIAR WITH AND=WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O�"SO TH WINDSOR'S STREET GUT"PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
6/9/2015 8:25 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
y PERMIT NO:; / -T-490 0- CONTRACTOR: (0/6J l S
LOCATION:
TYPE OF WORK: 4,
DATE INSP NEEDED: - DATE INSP: .? 11 lc
INSPECTED BY: 13b
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: /
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl.No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
} L FEE $25.00
Name of Firm 1 `\7 TrC Phone Na. ?6o-7%
Address of Firm 0. it�0 7► Zip Code a 6 07 Lil
Location of proposed work A78
Describe fully nature of permit requested vi
Starting date S Approx.time for completion -91-- 15-
Call Before You Dig No. 26 I 2'0bgb Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est.Patch Size(s) sf
j Est.Pvt.Thickness in.
P14 Est.Patch Unit Price
Est.Patch Cost$
p�Ve�� S� Est.Curb Replacement ft
Ca 66 r oil
� ��� j Est.Curb Unit Price$ /it
G�(,�n Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
O Cash O 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 AS T I DIN WN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
� C U
Title: A(k P�v�n� a I J/�'1L� Driver's License#: ���� 1 K 3;q )3
_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 I0-22-08