HomeMy WebLinkAboutStreet Cut Permit 104 Andreis Trail 1000005 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
_ STREET CUT PERMIT
DATE: 01/12/10 "
GIS ID: 03300104
MUNIS APPLICATION# 201000023 i FEE: 25.00
POO
RATION DATE: 01/12/11
CC
APPLICAN OCATION
NAME: CABLE CONSTRUCT
ADDRESS: P O BOX 159 jO. AND IS TRAIL
.CECELIA J
MIDDLEFIELD,CT 0 4 LEIS TRAIL
PHONE 860-649-8217
�� sh 3�OJTVINDSOR,CT 06074
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WORK DESCRIPTION: HA ` TL F9 1
APPLICANT AGREES TO FURNISH THE TO
THE TOWN OF SOUTH WINDSOR FOR ANY A 0 FS U B H =tF ND REQUIRED AND TO REIMBURSE
O CONNECTION WITH THIS PERMIT AND THE I � T .j'D AINTENANCE OR REPAIR WORK IN
,- LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SC
nEiT- ITMANUAL.
ISSUED BY DA E SPECTED INSPECTED BY
1/12/20108:58AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 100000S CONTRACTOR: (Z'hIe
LOCATION: a /
TYPE OF WORK: 1�af
DATE INSP NEEDED: DATE INSP: /(0 /d
INSPECTED BY: E
WORK IN
PROGRESS: Cow r4''wc`10 r
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C� DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
00,:�k3 APPLICATION FOR STREET EXCAVATION PERMIT ®s
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm �A-
' r.(� f' �� ; /'Y�c fi-G. Phone No. T60 v 3�7,)?01
Address of Firm tPQ Al i E ' of Zip Code MY5'a'
Location of proposed works T—(ta r
Describe fully nature of permit requested_ lrl•4C.P l4 `i ce
Starting date / 100 Approx.time for completion, tcJeeRS
Call Before You Dig No. ,61 oo30b;)86
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT 1S RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWNS CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or fumish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
0
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
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 OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed. /
Date: 0(l )(0
Title: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08