HomeMy WebLinkAboutStreet Cut Permit 09609999 Benedict Driv 1000166 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/16/10
GIS ID:BENEDICT DRIVE FEE: 25.00
MUNIS APPLICATION# 201001065 EXPIRATION DATE: 08/16/11
APPLICANT LOCATION
NAME: PETE&STEVE CONTRACTORS-& s ADDRESS: BENEDIT DRIVE
ADDRESS: 16 SCHOOL STREET OWNER; " TOWN OF SOUTH WINDSOR
P O BOX 1 1540 SULLIVAN AVE
TERRYVILLE,CT 0678 S WINDSOR,CT 060742734
PHONE
WORK DESCRIPTION: INSTIATON OF WATER MAIN REPLACEMENT CWC AVERY HEIGHTS
PHASE;l SECTION �,BENEDIC DR-SPRUCE.LN;PINE TREE LANE
37,
APPLICANT AGREES TO FURNISH THE TOWN OF'SOUTH WINDSOR THE;AMOUNT OF-WND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANI EPENSES,INCURRED AX'THE TOWN FOR,IVIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE AFPI IOANT4S FAMILIAR-?TI AHD WFT L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WIND R'S STREE.'T CUTPERIvIIT MANUAL.
ISSUED BY IJAfE INSPECTED INSPECTED BY
8/1 6/20 1 0 2:15PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
F
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: , / � CONTRACTOR: 4_S,4w
LOCATION: ce a p,
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7 - 1
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TYPE OF WORK:__i d1,S,fG
DATE INSP NEEDED: DATE INSP: f►j'%
INSPECTED BY:
WORK IN
PROGRESS:_ t/Jc-� /r cln
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C/two_ DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT j
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1640 SULLIVAN AVENUE Date: 0111to -
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm I�EtE aya S7EyE �)LzMA00PA as b 15b3aiwWft. Phone No. 13l60- 58cl-3&00
Address of Fi aou 1 1r6e.t!jvt r Zip Code 647rgf,-000 t
Location of proposed work_ SpR � LA✓E� j'gp1rr 1eAy4 dip �,,,,�'fiP. Lhu�
Describe fully nature of permit requested ��srra�I�-�r��,�
Starting dat_i3I 1�(tom . Approx.time for completion Z tK w-rks
Call Before You Dig No._Zoiu 330 ry�1 Existing Water Supply: ❑Public Water ❑Well
Z010 370 106 1 wib 33U t4d3 Existing Sewage Service: ❑Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
ILENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS.THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN AYEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish
two copies of separate drawing This section to be filled out by
Indcate North Town of.South Windsor
No.cuts
Est.Patch Size(s) sf
st'EPvt ickess in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$. /ft
Est.Curb.Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control S
AmL of.Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting paid By
the Police Dept.and CRY.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 WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATION FOR
PERMITS AS OUTLINED IN THE T WN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: l L 110
.Title: Utr.E i�ats►aE►�,- Driver's License m 6Q?,030G'73
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