HomeMy WebLinkAboutStreet Cut 70 Ayers Road APPLICATION FOR STREET EXCAVATION PERMIT 9OD�,
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00 G�,
Name of Firm 6
rt1 4- Phone No. �����'" r K `-
Address of Firm t Zip Code
Location of proposed work d "
Describe fully nature of permit reque ed v-P t� -77
Starting date f!E� 09 Approx.time for completion
Call Before You Dig No. Q--0 cr 2: 3 0/0y" '
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
'COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price
Est.Patch Cost
Est.Curb Replacement It
IEst.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
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 OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed��,% G� x -mac` Date: 2EZ OF
Title: s Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08.doc
800079 ��'
TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 06/05/08
GIS ID: 069000 70
F •MUNI FE
E:
E.AP P LI C AT I O N 2 00 2 80 5.0 00
81 7
� I"RAT
,.. :.:.<;>:::;..;::;::<::; ::� �:.:;:. ; :<::.. ION DATE•
06/05/09
APPLICANT` " ; :::.:::. . .::
IsOCATI NAME. QUALITY P AVING c0 ::: >:.<:.;>:>:::. , ON
Y S GOAD
ADDRESS: 194 S.MAIN STREET, ,,:<:<:<::: '<:,�<;:...:::;<�# .._ .:........:.:.:...., „s..�...; :;:... ;.
EAST WINDSOR, CT 608$ Q N R � -LINGO GIOVANNI&LAURA
ZL ' S ROAD
5
PHONE H WII'�DSOR CT
86
_ _ 06074
0 ,52 3 41 82
WORK RK
DE
SCRIPTION:
S C RIP TI O N•
. D
RIV
H
APP
LICANT
LI CAN T AG
REES
EE ST OF FU
RNISH
NI SH TH
E
E T O WN OF.'•,
O U T
T1i?IIJ. (33TIVIQ:III+IT C3I:$O`b HE TOWN OF SOUTH WINDSOR FOR ANYXPEIYtS,ES'IN: UR <> ''.`< :;.` ?` :'" " REQUIRED AND TO REIMBURSE
IN
CONNECTION WITH THIS PERMIT AND THE AI?I�LI ANTI 'FAI IJ �{t TH L ABIIDE BY THE RUTENANCE OR LES AND REPAIR EGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOi ITH:. .IIR?_ .STRFsT LIfiT PETIT MANUAL.
ISSUED BYV
D TE INSPECTED INSPECTED BY
6/5/200811:00AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: W 000 9 CONTRACTOR: c
LOCATION:
TYPE OF WORK: �.� \yt�t,,;a
DATE INSP NEEDED: DATE INSP: I
INSPECTED BY:
WORK IN
PROGRESS:_
/\,)° S �
AS-BUILT:
INPUT: (�, !'1 DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07