HomeMy WebLinkAboutStreet Cut Permits 4 Good Hill Road 1900140 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/15/2019 h,
GIS ID: 36000004 1 FEE: 50.00
MUNIS APPLICATION# 201901767 $XPIRATION DATE: 08/14/2020
APPLICAN Y ; , a fi LOCATION
NAME: AIROLDI'S INC ADDRESS 4 GOOD HILL ROAD
ADDRESS: P O BOX 71 ,I BEIRQ MARCIO
0 D HILL ROAD
SOUTH WINDSOR, CT� 6�Z4< s ti
PHONE
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WORK DESCRIPTION: WIAEI1JkNCiliEi1UA"�'l�EAROTTSIE"
APPLICANT AGREES TO FURNISH TH qu%m ors W b t�I 2PHE Afi�IQUIrTT'plf B.0ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN,Y XP NSES IC 1RRIrI?$ 'I HE,I 11 N oR4AAfNTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE AP%ICA L'E4R W TFT "W L'L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN bF S: V1 INDSOR'S:ISTRE$T CUT. IT MANUAL.
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'-lSSVEb B DA'TE Il*TSPETED INSPECTED BY
8/15/2019 12:19 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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Town OF SQUTI MOSDR INSPECffON REPORT
PfRMIt'NO.: q� I D CONTRAG' R:
ON:
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TYPE OF WORK: �?
DATE INSP NEERED•. DA-M INSP:. ro
INSPECTED
WORK:IN
PROGRESS:
SEPTIC TANK PtlMPEQ,,SMASHED, FILLED 1l1T1VESSED ❑YES [I NO
INPUT DATE:
$1mollayfiamts 2014 Tom Of South Windsor.Mp5fiON N I'OR714
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT i
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
FEE $E2-W
Name of Firm �'�'' £(�)D Phone No. b 30�' 0�7j
Address of Firm v Zip Code
Location of proposed work &Z C
Describe fully nature of permit requested Dom- ��
Starting date t_ Approx.time for completion
Call Before You Dig No. rion Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
0 No.cuts
Est. Patch Size(s) sf
r [ Est. Pvt.Thickness in.
t Est.Patch Unit Price
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
d ^1 Est.Traffic Control$
Amt.of DeposIt$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police Dept.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 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 OUTLINE IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
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Signed: ( Date:
Title: r Driver's 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