HomeMy WebLinkAboutStreet Cut Permit 75 Wendy Drive 900115
PERMIT NUMBER TOWN OF
SOUTH
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STREET CUT PERMITDATE: 08/13/09 "+ ,,,,\ ,\gg,\�GIS ID:93000075
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APPLICATION# 200900958 "` °\` \''\
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Q\�A�VwnAw o 25.00TION DATE: 08/13/10wwAPPLICAN
NAME: V+' 1A1AN1A\ , \\\V,VA vv+,VVv�q�Ij
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ADDRESS: P O BOX 71INC. 1 atin�\\\`\\ 1. au \ ��\,\\\\\` �\\\\„ \+ \�\'\ � � �I'�CATI
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WINDSOR n \�h KI DONALD JOHN
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WORK DESCRIPTION: DRI nn„n� vv av�� vv� v, �� wa,n
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APPLICANT AGREES TO FURNISH THE \\1\ �\vvn,wvl\vv�ynw,a n „`�`ov n+v0 �wAv
THE TOWN OF SOUTH F',
WINDSOR FORA n\ n" `� 0 ND REQUIRED AND TO REIMBURSE
CONNECTION WITH THIS PERMIT AND THEINCa\
FOR PERMITS AS OUTLINED IN THE TOWN OF
F,a+,;,�;nn,�„�,„ �`a '� TENANCE OR REPAIR WORK IN
^�'' \A �L ABIDE BY THE RULES AND REGULATIONS
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ISSUED BY DATE INSPECTED
INSPECTED BY
8/13/200910:37AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOa INSPECTION REPORT
PERMIT NO.:�p o I LIL CONTRACTOR: i w l c�► 'S
LOCATION: '� h
TYPE OF WORK:_
_---- ..DATE INSP NEEDED: DATE INSP:
INSPECTED BY: t3lb
WORK,IN
-PROGRESS: ;' s
AS-BUILT:
INPUT': DATE:_
W/2007 Town of South Windsor INPSEMON REPORT 07
a 009 p09.s g APPLICATION FOR STREET EXCAVATION PERMIT 9008.
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT jo a
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm Phone No.
Address of Firm 0Lfi Zip Code �d _
Location of proposed work
Describe fully nature of permit requested �Iv
Starting date Approx.time for completion D D�
Call Before You Dig No.���-z"ayg3j Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
0
Est. Patch Size(s) sf
Est.Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
pi Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
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
CONNECTION WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OU INED N HE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: F5 ( d
Title: Driver's License M
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