HomeMy WebLinkAboutStreet Cut Permits 120 Old Farm Road (4) 1700071 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 04/19/2017 = '
GIS ID: 66300120
,. FEE: 25.00
MUNIS APPLICATION# 201700394 V. PIRATION DATE: 04/19/2018
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APPLICANT' /y`` LOCATION
NAME: AIROLDI'S INC. �k ADDRESS k WOED FARM ROAD
ADDRESS: P O BOX 71 'OWNER IJELM6NTE JOHN D
SOUTH WINDSOR,C�`0¢0'14 120 tLD FARM ROAD
" SOUTH UVINDSOR,CT 06074
PHONE '
WORK DESCRIPTION: DRTVEWA ' t 3
APPLICANT AGREES TO FURNISH THE�TOVSWN ffioxmw Offlftbm BAND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANI' XPLNFS INQ $ED,BY THE TO'. FI� 1IAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TM APPLANT�S'IAIvIItiIAR WITH ANp1II:L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O SOUTH WINDSOR'S:S>R>;ET Gib p RMIT MANUAL.
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ISStTED BY DATE INS=PELTED INSPECTED BY
4/19/2017 3:21 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 760 1 - CONTRACTOR:
LOCATION: 't . cQ
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED
WORK IN
PROGR
SEPTIC TANK PUMPED;SMASHED,FILLED WITNESSED ❑YES ❑NO
AS-BUILT:
INPUT: DATE:
S/moiloy/forms 2014 Town of South Windsor INP5EC1' N REPORT 14 "
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT , , /�
1540 SULLIVAN AVENUE Date:/�T
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm \ `�'�`� Phone No.
Address of Firm Zip Code
Location of proposed work ' —0
Describe fully nature of permit requested
Starting date Approx.time for completion S 1
Call Before You Dig No. t5 D 0-1 Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE EATER THAN A YEAR.
Show sketch of proposed work or furnish This eclion to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
Z Est. Pvt.Thickness in.
Est. Patch Unit Price
1 _-..,_._.........
Est.Patch Cost$
Est.Curb Replacement ft
s. Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ Ihr
Est.Traffic Control$
Amt.of Deposit$
{ Total flue$.
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.B.Y.D.
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 OUTLINED N `TOWN Olj SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
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Si ned: �'` � Date:
Tige:'° - Drivers 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