HomeMy WebLinkAboutStreet Cut Permit 2849 Ellington Road (3) 1000204 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/23/10
GIS ID: 30302849
-
FEE:
25.00
MUNIS APPLICATION# 201001296 IRATION DATE: 09/23/11
APPLICAN LOCATION
NAME: FOLSOM CONSTRU 6
W =s - RE� 249 EL 1NGTON ROAD
ADDRESS: 138 RYE STREET
- = � _ DE REAL ESTATE INVESTORS
SOUTH WINDSOR, 3 - DR
AMR-
TINDSOR CT 06074
PHONE 860-528-8928 I g '
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WORK DESCRIPTION: WAT 8�� A1CUT ON
NIED WE
AV
APPLICANT AGREES TO FURNISH THEOTTH= M ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FORA p C T ' AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE I - L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF T
,�� ��`� �P� IT MANUAL.
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ISSUED BY DATE INSPECTED INSPECTED BY
9/23/20103:25PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I b00o?O y CONTRACTOR:
LOCATION: a i n G ern eQQe
TYPE OF WORK:_ JA)a `F-�� � C�Z� Nrl /IBC%Gler&t1PrA'
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: /3
WORK IN
PROGRESS: �o v► �i a c.t-oi /I'ta- �.. 7 jc (o C ,� '
Te
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: (-YA- DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
0 APPLICATION FOR STREET EXCAVATION PERMIT
Appl.-No. TOWN OF SOUTH WINDSOR Permit N .
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
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FEE $25.00 e;
Name of Firm d &-A)s Phone tkg&0 6SE-o i3
Address of Firm ; Zip Code a,.-1
Location of;proposed work 2v6 G r e r e,•
Describe fully nature of permit requested
Starting date Approx.time for completion
Cali Before You Dig No. Existing Water Supply: ❑Public Water Well
Existing Sewage Service: QRublic Sewer 0 Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND.CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A'YEAR.'
Show sketch of proposed work or furnish This section to be filled out.bv
two copies of separate dr ing , al Indicate North Town of South Windsor
V V c7� No.cuts it
Est.Patch Size(s) k g� sf
Est. Pvt.Thickness c in.
Est.i Patch Unit Price$a, 7 /sf
Est.Patch Cost
Est:Curb Replacement ft
Est.Curb UnitPrice
Est.Curb Cost$` r
Est.Traffic Unit Cost$ _ /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 :
1 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
C NECTION WITH THIS PERMIT AND THAT[,AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND.REGULATIONS FOR
PE S AS:OU D IN THI;TOWN OF SOUTH WINDSOR'S STREET CUr PE MIT 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
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towx't. MAP TITLE Data provided by SBC under contract and is based on an
aerial flight performed in spring of 2005. This map is a ftl5ouffihWindsor graphical representation of property information and is
MAP SUB-TITLE TOWN LINE PARCELS subject to change. The Town of South Windsor and SBCis
co, inch = assume no legal responsibility for information depicted on
�� feet this map and is to be used for planning purposes only.
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