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HomeMy WebLinkAboutStreet Cut public utility 25 Sharon Driv JUL. 30, 2008' 11 :29AM °MDC OPERATIONS'`r`n winasor Town Hall NO. 862 P. 3 �aosioos AP PL'ICATION FOR,STREET EXCAVATION PERMIT' 'Pl• No. TOWN OF SOUTH WINDSOR Perinrilt No. PUBLIC WORKS DEPARTMENT TOWN HALL . 1640 SULLIVAN AVENUE SOUTH yYINDSOR,CT 06074 FEE $25,00 Name of Firm ACT^R 0PO L l jrW Dl r2!CT Phone No. 7 - d, 7C 3 2 Address of Fi 2$ �)e(W��42 l 2� � Code Location of proposed work, N IVY V�D NG Describe fully nature of permit requested �Y/{`Tiitlf. VM e.l?' i.r n'7 0 l" J'f1A1`dAIr , r v r : 2 Starting date APPrOX time for completion D(d' Cad Before You Dig No. 2cog 3 oot 2 PLEASE NOTE THE DEPOSIT FOR THE PERMANENT.PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY EST4MAT1E. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENTo INCLUDING ANY INCAT.CN AREA CURB ...,LENGTH,TRAPPIC CONTROL AND THE TOWN REas<wS IN P '8 CONTRACT COSTS. THE PERMANENT PATCH lS.TYPICALLY CORApLIrTEp WITHIN A YEAR OF THE'TEMPORARY PATCH BUT IT COULI'BE LATER THAN A YEAR. Show at two coo �$ •* Ibis seetion to be filled out lnv Indcate North Tavern of SoQh Windsor 8 •I 2e5 'No.ats14 . r Est:Pa0h S>te(s) > + .� Est PA Thickness o Est:Patch Unit Price $ - 4f Est.Patch xc seIpf Est,Curb Replacement��}t Est.Curb Ueit Price$. Est.Curly Cost S 4 JUDY Est.Traffic Unit Cost$ /hr -�'•� Est.Traffic Control$ Z e: Amt.of Deposit$ . d . In Total Due APPlica I )Cash the Pot E39 Paid By 240 I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND NEQUIRED'AND TO REIMBURSE THE TOWN OF SOUTH W114DSOrR FOR'ANY EXPENSES INCURRED EY THE TOWN FOR MAIM"ENANCE OR REPAIR WORK IN . CONNECTION WITH THIS PERMIT AND 7MT I AM FAMILIAR WITH AND W PE ILL.ABIDE By THE RULES AND REGULATIONS 1=0R PERMITS AS OUn tNEQ IN THE TOWN OP SOLrrH WINDSOR'S STREET CUT PERMIT MANUAL. •Signed: - � Date: Title: Dtivees License#: i PERMIT SHALL BE KEPT ON.I6sum AT ALL TIMES Street Excavation Permit 08.doc t ' 4 TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.:,9D` 0 I CONTRACTOR: LOCATION:. 4*_ S 6rorl TYPE OF WORK:=�_�x���� DATE INSP NEEDED: DATE INSP: 3 OQ INSPECTED BY: ,� WORK IN PROGRESS: U44- c AS-BUILT: INPUT: C VA DATE:_ 7i" lb R W/2007 Town of South Windsor INPSEMON REPORT 07 800129 PERMIT NUMBER TOWN O F SOUTH STREET CUT N D S � R C T PUBLIC BLIC UTILITY DATE: 08/01/08 ,> GIS ID:82500025 '''��� ``. '"' �k MUNIS LIC APP ATION# 200801168 FEE: APP : .= 'IRATION DATE: 00 NAME: METROP AND s ty ADDRESS: 125 MAX M ROAD =x" Y w r w LOCATION HARTFORD � Y ' � Rl � SIARN DRIVE CT 0611 O EY Y LAC' ' RISTOPHER J&# f VE LAURA G PHONE z $' tt2wPTAR QN DRI "f v w DH.WINDSOR yy w WORK DESCRIPTION: • �c APPLICANT AGREES TO F URNISH TH EI ; ;IRON DRIVE ' x €s<: " ' x THE TOWN OF SOUTH ©F ;': k'. WINDSOR FOR ANY,E CONNECTION WITH THIS PERMIT AND THE"' F.,iS ,: AND REQUIRED AND TO REIMBURSE FOR PERMITS AS OUTLINED IN THE TO WN pp j"T'r . R �LL AB I?�ICN ISM..,> ,' '.: hf �0..SMAINTENANCE OR REPAIR Wpm{ T TI > IN S Tuft IDE BY THE RULES AND REGULATIONS Sk, IT MANUAL. C m v r Qf �. ISSUED BY DATE 8/I/2008 9:32 AM *** PERMIT PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** SpECTED BY