HomeMy WebLinkAboutStreet Cut Permit 20 Herman Way PERMIT RMIT NUMBER TOWN OF SOUTH WINDSOR, CT-
STREET CUT PERMIT
DATE: 10/14/08 q "
" 3
GIS ID:41700020
FEE:
MUNIS APPLICATION# 200801604 J f `' �; '`;.'VZ < ' 25.00
'; £ ' ; 'r ^:, `> RATION DATE: 10/14/09
APPLICANT ` F fig.
NAME: CONNECTICUT Celt: }" OCATION
" �, IE�IAN WAY
ADDRESS: P O BOX 159 €` � �,':� wry �'�� � � fr
lo
TERJ�SSICA
MIDDLEFIELD,CT6
{ r� iAN WAY
074
PHONE 860-349-1807 x� .: ��'�5.}y `��• �':�:�:. �:,�,,�e..:� � R,CT 06
WORK DESCRIPTION: �r.H'.:
OPEhG ' :.. <: x
' VICE
20 Er;
Ali Al.
CANNED
APPLICANT AGREES TO FURNISH THE T '. s `
THE TOWN OF SOUTH WINDSOR FOR ANIf � OND REQUIRED AND TO REIMBURSE
L' ; ' I OF.1.0;% AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE P2 E: T; ��>` V T
r STD LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF Sa1�T S '.
"TI IT MANUAL.
K :l .;
ISSUED BY DATE INSPECTED INSPECTED BY
10/17/200812:10PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:-3 00I CONTRACTOR:
LOCATION: D
TYPE OF WORK:_ �� � t l cea
--DATE INSP NEEDED:
DATE INSP: / z
INSPECTED BY: /3 A
WORK IN
PROGRESS: yr�
AS-BUILT:
INPUT: DATE:= SCANNED
W/2007 Town of South Windsor INPSECTION REPORT 07
1
- APPLICATION FOR STREET EXCAVATION PERMIT SO O—
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL .
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm �fi G Cos�l1�. I�fi Phone No. 8�C)
Address of Firm�o•2�PM L tQ LA tt:S�4=REIJ:�) 4= Zip Code
Location of proposed work ZQ4 L WAV
Describe fully nature of permit requested j-- 'ip'a, -Ac-EtT -n SO�GE 49
Starting date Approx.time for completion I 1 I 1
Call Before You Dig No. 7A08 AZ3�
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est:Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ fit
Est.Curb Cost$
Est.Traffic Unit Cost$ Ihr
Est.Traffic Control$
Amt.of Deposit$
CANTotal Due$
d: ( )Cash ( )Check#
N,
Applicant is responsible for contacting Paid By
the Police Dept.and C.B.Y.D.
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: Date:
Tide: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08.doc
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