HomeMy WebLinkAboutStreet Cut Permit 00 King Street PERMIT RMIT NUMBER TOWN OF SOUTH WINDSOR, CT
STREET CUT PUBLIC UTILITY
DATE: 03/30/09 I ".
GIS ID
50409999
APPLICATIO `} `
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MUNIS N# 200900254 ; ,,,xx.,� .,f,Y��., :} FEE: .00
w E R1RATION DATE:
APPLICA ITT
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NAME: CL&P =Y ',,LOCATION
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ADDRESS: 48 TOLLAND STA( E DING STREET
TOLLAND C �. 0 SOUTH WINDSOR
T 0604� . , ,..; � L IV AN AVE
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PHONE �:
860-871-3443 <R CT 060742734
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WORK DESCRIPTION: INSTy fi
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APPLICANT AGREES TO FURNISH THE
a w tPflND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY XDS =ICt F TrO �FOI�IAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE PL ,T
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FOR PERMITS AS OUTLINED IN THE TOWN OF 5��,7 gs� �' ABIDE BY THE RULES AND REGULATIONS
IT MANUAL.
ISSUED BY DATE IN ECTED INSPECTED BY
3/30/20093:35PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: / Oo®/ CONTRACTOR:
R
LOCATION:_
TYPE OF WORK:_ 5-f'14 1 I �Vp (mod�� L
DATE INSP NEEDED: DATE iNSP: a oy
INSPECTED BY:
WORK IN
PROGRESS: Tr'e-e5 j
Gi j s n�of-
AS-BUILT:
INPUT: off' DATE: 1
W/2007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
1540 SULLIVAN AVENUE Date:y /
SOUTH WINDSOR, CT 06074
FEE $25.00 ZD&�
Name of Firm
Address of Firm L Phone No.
O L L /fib
Location of proposed work 1,1 CS p— Zip Code U
Describe fully nature of permit requested �51;-'4 Z/ Ve 125,
Starting date
Call Before You Dig No. Approx.time for completion
Existing Water Supply: �DPub�ficat�er0�Well
Existing Sewage Service: ❑ Public Sewer PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT Ia Septic
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or fumish
two copies of separate drawing This section to be filled out b
Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement__ff
Est.Curb Unit Price$__/ft
Est.Curb Cost$
Est.Traffic Unit Cost$__mr
Est.Traffic Control
Amt.of Deposit$
Total Due$
( )Cash O Check#
Applicant is responsible for contacting the Police Dept.and C.B.Y.D. Paid By
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:
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