HomeMy WebLinkAboutStreet Cut Permit 855 Chapel Road (3) 1000167 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/18/10 "
GIS ID: 18000855 - A
MUNIS APPLICATION# 201001081 - FEE: 25.00
APPLICAN - 3
' RATION DATE: 08/18/11
PDS ENGINEERING � LOCATION
IT# = , RE BCH EL ROAD
ADDRESS: 107 OLD WINDSOR -�
4 L POINT CHRISTIAN CHURCH
BLOOMFIELD,CT 0 0( :.145
9d " SOR CT06074
PHONE 860-242-8586 '
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WORK DESCRIPTION: INST 1� 5 A - UJD FOR COLONIAL PT
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APPLICANT AGREES TO FURNISH THE N1161iTII= AM ( ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR 1Y CU - TIT AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH I A L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF IJ�TIUJ1I � £ P' IT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
8/18/20103:29PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CEO/0 7 CONTRACTOR: zl
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: o iv
INSPECTED BY:
WORK IN n'
PROGRESS: SJ
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: iVv�- DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm i P� ter✓) ,4e&l', Phone No.
Address of Firm 10-7 Old 1-✓;n 56V XJ Zip Code 0E:20.;L
Location of proposed work CALtf c I
Describe fully nature of permit requested r4.5 4 A it`.li a /o,TC.!%ae,l
Starting date ��`� /�1 Approx. time for completion OZA7/1
Call Before You Dig No. Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing - A Indicate North Town of South Windsor
�aer4�P(OU�(!► Q�4f15 . No.cuts
0` Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ At
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.
f 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
CONNECT N H THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS L D I HE TOWN OF SOUTH WINDSOR'S STREET CUT PF�RMIT ANUAL.
Signed: Date:R k2 f O
Title: (� l'L Driver's License#: trj O L6�Zo a
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