HomeMy WebLinkAboutStreet Cut Permits 276 Quarry Brook Driv (2) 1500092 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/02/2015
GIS ID: 74100276 FEE: 25.00
MUNIS APPLICATION# 201500635 EXPIRATION DATE: 06/01/2016
APPLICANT = LOCATION
NAME: AIROLDI'S INC. Alf, e DIIRESS ± STARRY BROOK DRIVE
ADDRESS: P O BOX 71 � RHAGL 1D CARL J&ROSALIND F0
SOUTH WINDSOR, CTI- 060.74 27lio, AI Y BROOK DR
`"S0U-T=H WINDSOR,CT 06074
PHONE -
WORK DESCRIPTION: DRIVIyWY
APPLICANT AGREES TO FURNISH THE*WNAF SOUTH WIIVI}SC?I THE AMOUIaI`P OFrBONI3 REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN TO FUk`M&TENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THIr1PJ'LICAI�L� IS,FAIVIILIAR WI"I HANI➢WILD ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO WN OF OUTH WINDS R'S STRI<E I CUT p- T MANUAL.
IS SUED BY jDATEFEC Ib INSPECTED BY
6/2/2015 9:33 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: A ) ✓o l01l S
LOCATION: J7 & Olzlic(�i ?JAook 122
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT-
INPUT: VA— DATE:
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06 74 FEE $25.00
Name of Firm `�" ' S '�• Phone No.
Address of Firm Zip Code ''I
Location of proposed work `�`� v:Z,�"c1
Describe fully nature of permit requested
Starting date Call Before You Dig No
-: PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
Est.Patch Size(s) sf
� �g� Est.Pvt.Thickness in.
n
0
Est.Patch Unit Price$ /sf
'Zo Est.Patch Cost$
~ Est.Curb Replacement ft
e: Est.Curb Unit Price$
4 fit
Est.Curb Cost$
Est.Sidewalk Replacement sf
Est.Sidewalk Unit Price$ /sf
` Est.Sidewalk Cost$
3 Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Arnt of Deposit$
4 : Total Due$
{ )Cash O 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 1� FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
;VVIIVDSOR T CUT PERMIT MANUAL.
Signed: Print Name ���\ ' �'" Date: r
:` Street Excavation Permit 2014