HomeMy WebLinkAboutStreet Cut Permit 2849 Ellington Road (2) 1000233 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER _ STREET CUT PERMIT
DATE: 11/18/10NU
GIS ID:30302849 FEE: 25.00
MUNIS APPLICATION# 201001558 g " IRATION DATE: 11/18/11
APPLICAN LOCATION
NAME: BOYKO CONSTRUC A i :VRES` y .q9 EL%-.INGTON ROAD
ADDRESS: 297 DUDLEY TOWN AN � T. E REAL ESTATE INVESTORS
WINDSOR,CT 06095 -A AR DR
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J� =INDSOR,CT 06074
PHONE
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WORK DESCRIPTION: D
3" -' } �2
APPLICANT AGREES TO FURNISH THE T FS433JTIR O ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FORA XP C AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE I1 L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF '-S, T IT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
11/18/201011:08AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I( Sa,3 ; CONTRACTOR:
LOCATION:
TYPE OF WORK: �r\
DATE INSP NEEDED: DATE INSP: r
INSPECTED BY: Ro
WORK IN
PROGRESS:_?0 Cfr�kc Ak
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT /000c�—
Appl. No. TOWN.OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1640 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
FEE $25.00 _',ej i. s
Name of Firm__ l (� q2SZ" - y��,,j„ Phone NA�0 a87
Address of Fi
� Zip Code Zn 60'FS
(� Location of proposed wort
Describe fully nature of permit requested ,��,tl
Starting date Approx.time for completion
Call Be'or a vo�D f`lc�._�a ' 7 y Existing water Supply: rT publio Water !Nell
Existing Sewage Service: Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY.ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE.FULL.FINAL COST.OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed wo*or'umish This seMion to be filled out by
two copies of separate drawing
Incleate.Nvrth - Town of.South Windsor
d � 6b r ' No.cuts
Est.Patch Sizes) f
Est-PvL.Thickness- in.
Est.Patch Unit Price S - /sf
-o— /`�/.� F.st.Patch Cost
J?/LS &L) Est.Curb Replacement ft
Est.Curb Unk.Pdoe
Est.Curb:Cost-$
Est.Trafrrc Unit Cost$ Ihr
Est.Trafflo Control$.
Amt.of Pe It.$.
i JVD L F' CA J6_Y
Total Due
Applicant is responsible for contacting Paid By
the PoliwPwt.and CA.Y.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 REGULATIONS FOR
PERM tT OUTLINED IN THE TOWN OFSOUTHt WINDSOR'S STREET CUT PERMIT MANUAL.
Signj 17 Date:
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