HomeMy WebLinkAboutStreet Cut Permit Avery Street (2) 800132 TOWN OF .SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
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DATE: 08/01/08 `�
GIS ID:06309999 FEE: 00
MUNIS APPLICATION# 200801176 F ' IaRATION DATE:
08/01/09
APPLICAII
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NAME: UNDERGROUND CO1�� ®N
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ADDRESS: 110 DAY STREET :. `' "
NEWINGTON,CT 0 lg £ OF SOUTH WINDSOR
�' ` SUtIVAN AVE
s bTTH WNDSOR,CT 06074
PHONE 860-436-3717 a
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WORK DESCRIPTION:
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APPLICANT AGREES TO FURNISH THE T VC�OF S(UI BIND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A7 X' ,: ES fC V*46 TvIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE P�C hJT S' IA "A"WELL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF
IT MANUAL.
ISSUED BY DATE INS ECTED INSPECTED BY
8/1/20083:12PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: b0 3 a- CONTRACTOR: \,) ACLOA ynd (�D1r1 '' ie
LOCATION:_
TYPE OF WORK: T 1 its J
- DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: g 7 s P:4-s +o
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AS-BUILT:
INPUT: V r DATE:
W/2007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT o0 1
Appl. No: TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT .
TOWN HALL 13
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
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Name of Firm f,�G� Phone No. �►
Address of Firm G 77 &4vi i j 729,1c" Zip Code 6 1
Location of proposed work A Y r
Describe fully nature of permit requested J, /�,`` 7?) UJC <.t✓G T�i 4!?4/vj
Starting date Approx.time for completion 991 3`0
Cali Before You Dig No.
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
'COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
��� dU2�t"1e�73 Est:Patch Size(s) sf
Est.PvL Thickness in.
EsL Patch Unit Price$ /sf
Est.Patch Cost$
jvD �c�e 7"OL�✓t J� Est.Curb Replacement ft
Est.Curb Unit Price$. /ft .
Est.Curb Cost$
Est.Traffic Unit Cost$ Ihr
Est.Traffic Control$
Amt.,of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.S.Y.D.
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 ITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS IN DIN T OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title: Driver's License#: cT
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08.doc