HomeMy WebLinkAboutStreet Cut public utility 65109999 Nutme 900073 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 07/13/09 .,: n. 4,7
GIS ID: 65109999
MUNIS APPLICATION# 200900784 % fi' : �u y ' FEE: 00
EI.RATION DATE:
APPLICAI 'TI,OCATION
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.NAME: METROPOLITAN DID " _
TROAD SO
ADDRESS: 125 MAXIM ROAD .
HARTFORD }� " : OI SOUTH WINDSOR
CT 06 s1 IV
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PHONE 6 0742734
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WORK DESCRIPTION: REP
, yM y: „ AAxED'50( FT SO OF GOVERNORS
APPLICANT AGREES TO FURNISH THE *BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR k"
� '. .; ... fiI`aTO `MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE IL j$NT� ` yjLL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF [ TIC
I� r OUTP RMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
7/13/200911:18AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSORINSPEM-ON REPORT
PERMIT NO.:__�.000 73 CONTRACTOR.-
LOCATION:
TYPE OF WORK:
.--_�--:- -.-;- --DATE INSP NEEDED: _ .
DATE INSP:-_ -92/;Z,//r o
INSPECTED BY:_ 8 D
WORK JN
PROGRESS:_ <�•� ✓.�z cr �,��- CA
AS-BUILT:__.
INPUT: 2� DATE:_ S�l
W/2007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT 96bO 91 .
Appl.No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm 1 ' 1 bc, Phone No.
Address of Firm Zip Code
Location of proposed work
Describe fully nature of permit requested_ .n I CCZ 4� wo n:E L /
Starting date Approx.time for completion
Call Before You Dig No. Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS.THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish
two copies of separate drawing This section to be filled out by
Indicate North Town of South Windsor
No.cuts
Est.Patch Size(s) sf .
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ fir
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting pal 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 OUTLINED IN.THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
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
r .
THE METROPOLITAN DISTRICT- PAVEMENT CUT DATE: '7 -Jo o9
BILL JOB YES GNO❑ WO#-Ale)I 4,o dj 3
N 9
hvi?RESS d--,nVje5R1yoA.5 -A(Yf Y . TOWN 4, tdiWQ_!!?49 STATE+MIGHWAY YES El NOLV
DRAW SKETCH SHOWING LOCATION AND SIZE'OF CUTS AND CUT MADE W
o GROSS SECTION OF PAVEMENT ) '
r- - STREET 14 BIT.CONG. Is- CONCRETE D PREMIX ❑
o - SIDEWALK BIT,CONC. ❑ CONCRETE D FLAG D
CURB >r' BIT.CONC. lam' CONCRETE ❑ STONE
I DRIVEWAY BIT.CONC- ❑ CONCRETE ❑
GRASS 1/ LOAM &SEED NEEDED YES D NO 9�r-
QREASON FOR CUT:
� y.V
NUMBEROFGUTS: J
- `�---C� DATE OF FIRST CUT
Q IS JOB COMPLETED: YES W NO❑ '
Q FOREMAN: �d
�_c-, A
� r REPLAGEMENT PAVEMENT CONTRACT NO.:
BIT.CONC. D CONCRETE D PREMIX ❑
DATE COMPLETED:
ACCOUNT NUMBER: t
CALCULATIONS
OF CUT ITEM ITEM* ITEM# ITEMS
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PRESS HARD, 3 COPIES (ORIGINAL) OPERATIONS
$ �'L(WI SERVICES coy R A