HomeMy WebLinkAboutStreet Cut Permit 244 Smith Street APPLICATION FOR STREET EXCAVATION PERMIT 90015c>
Appl.No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: << )0
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm_ N"�C.IA't& (2k-"xs t WC• Phone No.
Address of Firm �`� ����t»m�QC'J'; Uj A Zip Code (YE)6-7+
Location of proposed work `�`�Lf f'11m-H 'i;A6-_ "
Describe fully nature of permit requested eXCAQP•"[i�5 F{2- i(),gTSe_—TA9
Starting date 4 ! ra Approx.time for completion Z !NiLfS
Call Before You Dig-No. ZZCSR7� IAA L Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST.OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
i.ENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS.THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing This
Town of South Windsor
No.cuts
-
Est.Patch SIze(s) sf
Est.-Pvt..Thidmess 4- in.
Est.Patch Unit Price$ 2 /sf
Est.Patch Cost
to
'►ALL Est.Curb Replacement ft
Est.Curb Unit.Pdoe /ft
Est.Curb Cost$
IlllbLk,UISD�c1L � Est.Traffic Unit Cost$ /hr
i ��- 4'fL S�Wltc Est Traffic Control S
\(k9 Amt.of.Deposit$ _750,�
Total Due$ S
fJJ4. USqj7j:�Z f IS 4A41 ( )Cash WCheck# 4 603
Applicant is responsible for contacting CSX6 J Paid By StAT -
the Police Dept.and C.B.Y.D.
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN TH-WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNE TIO WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMI A OUTLINED IN THE T.<MN O UTH WINDSOR'S STREET CUT PERMIT MANUAL.
Sign Date:
Title Driver's License#:
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OF PERMIT
WORK MAY NOT BEGIN UNTIL A PERMIT HAS BEEN ISSUED
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08 REV 10-22-08
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900150 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 11/10/09 a�� "v`� a " \
���o �V� ��� " �p
GIS ID: 83700244w��w v,"� v`\
.FEE: 25.00
MUNIS APPLICATION# 200901380ERATION DATE: 11/10/10
APPLICANTOCATION
NAME: J&H SLATER CONS a°\\ a` \,' \\\\ \\\ a\\ S I \ STREET
ADDRESS: 75 COMMERCE WA
� � �4 SI t
SOUTH WINDSOR, \ \ 1 \\� "\\a\ \\\\ a\`,\`\`,aa;;;,.\\\\\J;\ `` 1ER`"`\\ \\\3�X \404 BRON AVENUE LLC
\ \ 239 M ST
URY CT 06033
PHONE 860-528-5252
WORK DESCRIPTION: EXCA ,,ATEv R`�V E °5`ER
A\\V� �� ph�N����� AV\\p�`�A Vb\\V�\
\ \
APPLICANT AGREES TO FURNISH THE TO 4pul ,\ �F;BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY E MiENSIE&IIJCURU '„THE T(�\, p MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE AP �TCAN �$ Ii IAt"v A�iI3'vWILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOU vo1CRUT`'�ERMIT MANUAL.
G�
ISSUED BY DATE MSPECTED INSPECTED BY
11/10/200910:51AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 9 CO�5V CONTRACTOR: "- �1a (Z
LOCATION: _ y ,Srn��t h Se
TYPE OF WORK: SSX( a \)0Ap_ .L A- \ e)C[ --eA- __�aQ
DATE INSP NEEDED: DATE INSP: // /7 c 9
INSPECTED BY: r;1�
WORK IN
PROGRESS: le QT C +�
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES [—] NO
AS-BUILT:
INPUT: Cs VY` DATE: � I- 1 sI C7 7
W/2007 Town of South Windsor INPSECTION REPORT 07