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HomeMy WebLinkAboutStreet Cut Permit 45 Newberry Road 1000212 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER STREET CUT PERMIT DATE: 10/07/10 GIS ID: 630OR001 FEE: 25.00 MUNIS APPLICATION# 201001369 EXPIRATION DATE: 10/07/11 APPLICANT LOCATION NAME: J&H SLATER CONST`CO ADDRESS:' R001 NE WBERRY ROAD 45 NEWBERRY ADDRESS: 75 COMMERCE WAY OWNE12: J E SHEPARD CO SOUTH WINDSOR,CT©6074 PO BOX 4`15 E WINDSOR HILL,CT 06028 PHONE 860-528-5252 WORK DESCRIPTION: INSTAL .WATER SERVICE 45 NEWBERRY ROAD APPLICANT AGREES TO FURNISH THE TOWN OF'SOUTH'WINDSOR THE=AMpUNT 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 THE APPLICANT IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH W1NDSR'S STREET CUT''PERMIT MANUAL. 1 ISSUED BY DATE IN PECTED INSPECTED BY 10/7/201010:41AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: C �I�� CONTRACTOR:-J-4 14 S LOCATION: Li TYPE OF WORK: \'oCG sl DATE INSP NEEDED: DATE INSP: INSPECTED BY: 60 WORK IN PROGRESS:_ SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO AS-BUILT: INPUT: C3 DATE: ill d R 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 f FEE $25.00 Name of Fi Phone No. 'a66 Address of Firm �� ' vtn f=t?,GC? (,t� Zip Code Location of proposed work s ijEW_5eR lzy k2_19. Describe fully nature of permit requested (f4sracs- (dAj!j& 5-aLVicF_ Starting date to 1T Approx.time for completion Call Before You Dig No. 1041 Qs L 65'5 Existing Water Supply: ❑ Public Water ❑Well Existing Sewage Service: ❑ Public Sewer ❑Septic PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR. Show sketch of proposed work or furnish This section It be filled out by two copies of separate drawing Indicate.North Town of South Windsor No.cuts Est.Patch Sizes) sf Est.Pvt.Thickness 4 in. Est.Patch Unit Price$ 2 6• /sf Est.Patch Cost$ Est.Curb Replacement N IN ft PaoLAST Est.Curb Unit Price$ /ft ttouWW V. Est.Curb Cost$ Est.Traffic Unit Cost$ N/Q /hr h.)�u) 14E—_WL (T_ Est.Traffic Control$ Amt.of Deposit `T Total Due ( )Cash (v�Check# 1011c } Applicant is responsible for contacting Paid By I SLAll--2 the Police Dept.and C.B.Y.D. AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN O UTH.WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNE I N WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMIT OUTLINED IN THE T WN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. Signed: Date: icj� 0 Title: Driver's License#: 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