HomeMy WebLinkAboutStreet Cut Permit 178 Smith Street 1000133 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 07/28/10
GIS ID: 83700178 FEE: 25.00
MUNIS APPLICATION# 201000947 -
RATION DATE: 07/28/11
APPLICAN .. LOCATION
NAME: KF CONSTRUCTION -�
t MI STREET
ADDRESS: 175 WHEELER RO � RTIES LLC
SOUTH WINDSOR, 4 WELER RD
SOR CT 06074
PHONE G -
-4
WORK DESCRIPTION: 1NST TRENCH FOR
WATE CO "
APPLICANT AGREES TO FURNISH THE T =� F ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY S -Si H AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE -P LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN.OF S` i �OT IT MANUAL.
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ISSUED BY DAT$INSPECTED INSPECTED BY
7/28/2010 11:57 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION:REPORT
PERMIT NO. J3( 3 CONTRACTOR:_ Af'
LOCATION: I
TYPE OF WORK: e
� a
DATE INSP NEEDED: DATE INSP: i0
INSPECTED BY:
WORK IN
PROGRESS: �`'�n � d� x 3 C
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT.
INPUT: DATE:
W12007 Town of South Windsor INPS crm REpORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
ii FEE $25.00
-Na.me of Firm l� �'TSU �'^ Phone No. P6
Address of Firm Zip Code 6d7�/
Location of proposed work M
Describe fully nature of pe" it req ested QCC$
tx
Starting date y Approx.time for completi n
Cali Before You Dig-No. Existing Water Supply: 09►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
i.ENGTH,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.69 filled out by
two copies of separate drawing Indicate North Town of.South Windsor
No.cuts 1
Est.Patch Size(s)__' sf
Est.PvL Thickness _3-q' in.
Est.Patch Unit Price tsf
Est.Patch Cost S �f
Est.Curb Replacement
. Est.Curb Unit Price
Est.Curb:Cost$
Est.Traffic Unit Cost$
S� Est.Traffic Control S
Amt.of Deposit S
t°n i Total Due S t'PZ"J
( )Cash (heck#
Applicant is Fespons a for contacting WIC Y`��,`� Paid By
the Police t.and C.B.Y.D. -1 Cop
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 TIJIS PERMIT ANA THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OU IN IN. OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date
.Title: ��-' _ Drivers License#: 5 /
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 Pem'it 08 REV 10-22-08
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