HomeMy WebLinkAboutStreet Cut Permit 765 Sullivan Avenue 900122 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
N,
DATE: 09/15/09 .
GIS ID: 87300765nr%"' L FEE: 00
MUNIS APPLICATION# 200901095 €wx, �` ` A 4 CATION DATE: 09/15/10
APPLICAlI w LOCATION
NAME: HERB HOLDEN TR*90. r
SSIJLL VAN AVENUE .
ADDRESS: 59 BROAD BROOK NTH WNDSOR TOWN OF
BROAD BROOK;CIOo� j �' L VAN AVE
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PHONE 3 '> . „n; : T WNDSOR,CT 06074
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WORK DESCRIPTION: EXC AfflI > ' h �WATET IN ALONG WEST RD
TOW RO E HOUSE
'� ,,� ' �°' � $T' FIRE
APPLICANT AGREES TO FURNISH THE T OFT:' 'i�dND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY I�WF�DIIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THEE Ip+ S T TI L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF 503. J TwP) tMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
9/15/20098:49AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: O CONTRACTOR: 601ol-en
LOCATION:
TYPE OF WORK:
W�aa r\
INSP NEEDED:
DATE INSP:
INSPECTED
WORK YN
PROGRESS: LA-)n 0
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AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INpSEMON REPORT 07
a?ao 9 dl 0 9.5' APPLICATION FOR STREET EXCAVATION PERMIT 9 00/. 'a
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
.1540 SULLIVAN AVENUE Date: !/�L//o
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm_4 -LbG"3 1 r2�S-kl L,/ I W, Phone No-1�1660 69 3-b tS 3-
Address of Firm-5-9 �� ;yp7g_e,, 6 8 6&Mk- , �— Zip Code 6 G 0
Location of proposed work (:23 a—
Describe fully nature oof rmit requested
Starting date 19 0 G�` Approx.time for completion
Call Before You Dig N . coo 3 C.c)9 cl Existing Water Supply: ubtic Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE:. THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH 1S TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate.North Town of South Windsor
No.cuts
Est.Patch Size(s) sf
Est. Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
GD Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
AmL of Deposit$
r Total Due$
o O Cash O 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
CONNECTION WITH THIS PER IT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS A UTLIN DIN H TOW F SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: - - - - -Date: . 7,11540 _ 7
Title: Driver's License#: 01 146
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