HomeMy WebLinkAboutStreet Cut Permits 104 Judy Lane 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# 201701278 EXPIRATION DATE: 0912I/20I8
k (
APPLICANT ' -; LOCATION
: :
NAME: AIROLDI'S INC. ADDRESS 1C4 JUDY LANE
ADDRESS: P O BOX 71 x 0 WNER 1VIOHS LIMBERLY&
SOUTH WINDSOR, T g6074 = 104 7LTIY LANE
SOUTH WINDSOR,CT 06074
PHONE
WORK DESCRIPTION: DRVEWAY `h
% i-. , F 4
APPLICANT AGREES TO FURNISH THI;:TO". OF SOUTH W#ND ()R-. I E'AMOUTVT( I bND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPEI*ISES INCURItI R BY TAE T.0% FOI MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT:;IS I'AMILIAR WITII1DI'LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO"SOUTH WINDSOR' S I I ET CUT PERMIT MANUAL.
'
ISSUED B DA oIN PELTED INSPECTED B
9/21/2017 9:00 AM ** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
s
u.
K'
#
ti
4
'v➢ v µ C <f E
�F
h _ `
C 1
y 4
I
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 00 CONTRACTOR:
LOCATION:_ 0 L/ �u �� Cd v--e- ... _
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: ab le
INSPECTED BY:
WORK IN
PROGRESS: Cj
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES D NO
AS-BUILT:
INPUT: DATE:. 514
'
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 $25.00
Name of Ffrm 4 �� f�^ j �"1VV Phone No.
Address of Firm X 7 h` d��rr`$ Wt A /` Zip Code OT
Location of proposed work Toq Jj f%
Desorlbo fully nature orf�permit requested.
Starting date 1 Approx.time for completion 3 17
Call Before You Dig No, Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service; ❑Publlo Sewer ❑Septic
PLC-AGE NOT w: 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
COMPLETED WITHIN A YEAR OF THIS 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 ooples of separate drawing Indicate North lowg gl South Windsor
No.cuts
Est,Patch Sizes) sf
Est.Pvt.Thldcness In,
Est.f atch Unit Price$ !st
Est,Patch Cost$
,J N 5` �'' o!' Est.Curb Replacement ft
Est,Curb Unit Price$ III
Est,Curb Cost
Eat.TrafOc Unit Cost$
get.Trafflo Control$
Amt.of Deposit$
Total Due$
( )Cash ( )Cheok 9
Appllcant Is responsible for contacting Paid By
e Police DWI.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 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'
Title: ra` I f�td��� Driver's LicenseqL
PLEASE ALLOW AT LEAST TWO WORKINQ DAYS AFTER APPLICATION FOR ISSUANCE;OF PERMIT
WORK MAY NOT 1312GIN UNTIL A PERMIT HAS BEEN ISSUE)
PERMIT SHALT.BE KEPT ON JOBSITE AT ALL TIMES
Street Excavatfon Permit 08 REV 10.22.08