HomeMy WebLinkAboutStreet Cut Permits 104 Judy Lane (2) 1.700207 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: -09/2 l/2017
GIS ID:48600I04
FEE: 50.00
MUNIS APPLICATION 4 201701278 EXPIRATION DATE: 0912I/20I8
LOCATION
APPLICANT
NAME: AIROLDI'S INC.
ADDRESS 104 JUDY LANE
Al
ADDRESS: P O BOX 71 x OWNER 1,VIOHS LIMBERLY&
SOUTH WINDSOR, T g6074 104 7LTDY LANE
SOUTH WINDSOR,CT 06074
PHONE
WORK DESCRIPTION: DRVEWAY `h
v '
APPLICANT AGREES TO FURNISH TH ;TOWN dF SOUTHW#NDSE)I; IE'AMOUIVT QI I30ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR,4NY EXPENSES INCURIti �Y xflE I pWl FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT:IS FAMILIAR WITIi 1D 4 ILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OP SOUTH WINDSOR IT MANUAL.
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ISSUED B DA- OINSPECTED INSPECTED B
912l/20I79:00AM ** PERMIT TO BE KEPT ON JOB SITE AT ALL TIN4ES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 0L CONTRACTOR: 16901 i-5
LOCATION:_ 0 L/ �u �� Cd v--e- ... _
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: Z
-b lie
INSPECTED BY:
WORK IN
PROGRESS: Cj
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES 0 NO
AS-BUILT:
INPUT: DATE:. 5- 14
S/mo!!oy/forms 2014 Town of South Windsor INPSEMON 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
FEE $25.00
Name of Flrm 4 �� f�^ j �"1VV Phone No.
Address of Firm X 7 h` d��rr�$ Wt A /` Zip Code �
Location of proposed work T Dq ,),J, f%
Desorlbe fully nature orf�permitrequestee.
Starting date 1 Approx.time for completion 17
Call Before You Dig No. Existing Water Supply: ❑Public Water ❑Well
Exiating Sewage Service; ❑Publlo Sewer ❑Septic
PLEASE NOTE.; TIME 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
COMPLETE)WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish XhigI
gn jo,be filled out by
two copies of separate drawing Indicate Nortit• xowg Qf South Windsor
No.cuts
Est,Patch Sizes) sf
Eel.Pvt.Thldcness In,
Est,f atch Unit Prrce$ !st
Est,Patch Cost$
j N `�" �''i o r Eat.Curb Replacement it
Est,Curb Unit Price$ III
Est,Curb Cost
Eat.Traffic Unit Cost$
get.Traffic,Control$
Amt.of Deposit$
Total Due$
( )Cash ( )Check 9
Applloant is responsible for contacting Paid By
e Police DWI.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 OIT REPAIR WORK IN
CONNECTION WITH IS PE N THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS70 &D I FSOUTH WINDSOR'S STREET CUT PERMIT MANUAL,
Signed: � Date' • � ��
3
Title: ;r a` I f�td��v� Driver's License HL
PLEASE ALLOW AT LEAST TWO WORKINQ DAYS AFTER APPLICATION FOR ISSUANCE;OF PERMIT
WORK MAY NOT 1312GIN UNTIL A PERMIT HAS BEEN ISSUED
PERMIT SHALL.BE KEPT ON JOBSITE AT ALL TIMES
Street Excavatfon Permit 08 REV 10.22.08