HomeMy WebLinkAboutStreet Cut Permits 18 Cambridge drive 1700191 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/01/2017
GIS ID: 16200018 `"
FEE: 25.00
MUNIS APPLICATION# 201701158 Y, 1XPIRATION DATE: 09/01/2018
AP
APPLICANT L 1„ ~ A ,„ LOCATION
NAME: AIROLDI'S INC. ADDRESS
v B�IyCAPvIBRIDGE DRIVE
ADDRESS: P O BOX 71 QWNER WMONTE EDWARD JR
SOUTH WINDSOR,101 6974 1$ CAM4RIDGE DRIVE
4 SOUTH"_SNINDSOR,CT 06074
PHONE
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WORK DESCRIPTION: DRfJHWA�Yt '
APPLICANT AGREES TO FURNISH TH1;�TOWY*I OF�.Oi1TH iINI�SiOR'TH$AMOUIVT�OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR 1 EXRENSES IN CII= I3Y`THE TJWl f FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TI`TEZT�T;CANT:IS FAMIT R WITH ANDL L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO
S(1JH Wf1VbSdR'S STREE BUT PERMIT MANUAL.
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ISSUED BY DATE INSPECTED INSPECTED BY
9/1/201710:35AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: J 7. v o a CONTRACTOR:
LOCATION: J �'�� r► q sz
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: �>
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSEC ION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00
Name of Firm___leLIL�I_'s, Phone No.
Address of Firm_ P�901 _? - 1NU�, C', _ Zip Code OA' l
Location of proposed work C? ,C3�/U G� -v/�
Describe fully nature of permit requested DUEPCf1
Starting date / 7 Call Before You Dig No
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR_
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
r No. cuts
Est.Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
Est. Curb Replacement ft
ol ..z_� Est.Curb Unit Price$ /ft
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Est.Curb Cost$
Est. Sidewalk Replacement sf
Est. Sidewalk Unit Price
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Est.Sidewalk Cost$
r Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
1-1e�— Amt.of Deposit$
Total Due$
Cash ( )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 AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDSOR §TREET CUT PERMIT MAN,AL
Signed .ti ' =J � Print Name f"�J�j�i�r�'�!� ` �OJ Date: fl) 7
Street Excavation Permit 2014