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APPLICATION FOR STREET EXCAVATION PERMIT 9 000c ' 3
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1640 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
c ,
FEE $25.00
Name of Firm 6fllco,A�rle-t Phone No. 6 L(74 3
Address of Firm 7 ( f ( Sj C Zip Code UCH 07
Location of proposed work 7 7 f l
Describe fully nature of permit requested U4 1A 5/'ff f
Starting date-2 oeeks Approx.time for completion
Call Before You Dig No.90091y 0 L9 aq Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
\ Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
v
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /it
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
U13�� Est.Traffic Control$
�/t�\ju 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
CONNECTIO ITH ?E '
ERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS A UTLI14THE-TT OF SOUTH WINDSOR'S STREET CUT PE MIT MANUAL.
Sig � Date: 9A
Title: Driver's License#: I I I V O � �p
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
s - •
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 9chn ?, CONTRACTOR:_1+bMea aN&_ - L a ogq ;
LOCATION: 7 a 'P I L°aSc y-,-►- Qa i t-c e ZJ
TYPE OF WORK: Vl s`fir9 ►tin G ur fiat r� a�-�a i `M 5*'�pe f-
—=----- = --DATE INSP NEEDED: DATE INSP: CQ 3 La 4
INSPECTED BY:_ Bp
WORK IN
-PROGRESS: 1-1� -O�v � T�5 r l�e a�- Two
Lill
°
AS-BUILT:
INPUT: C DATE:
W/2007 Town of South Windsor INPSECiION REPORT 07
900023 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
3K'
a :; °>
DATE: 04/09/09 ,�``'' '.� �.
GIS ID: 72900772ce"
MUNIS APPLICATION# 200900314 ,,. 6° FEE: 25.00
. v 4 'IRATION DATE: 04/09/10
APPLICANT
LOCATION
NAME: HOMEOWNER -L
ADDRESS: $ " 7 PLEASANT VALLEY ROAD
SOUTH WINDSOR C 6:`7 � "`
� - y A 'mAn RTGAGE
YM �.. .: t7 CORD
Am
y° z T GROVE DR
PHONE :..,." it,, x I a �, `R,SI�AVI,PA 19044
WORK DESCRIPTION: INS
i,.#, ec6„y: i:'s if i€ '+y,oYcn4 .•, i
APPLICANT AGREES TO FURNISH THE O
'" ffJP LAND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A E II�O . . . t
CONNECTION WITH THIS PERMIT AND TH F a'MAINTENANCE OR REPAIR WORK IN
PP C,• T I' T ND LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OFF 9,ST E UT IT MANUAL.
U4 , ,..
ISSU BY DATE SPECTED INSPECTED BY
4/9/20091:20PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***