HomeMy WebLinkAboutStreet Cut Permit 114 Benedict Drive 1000055 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 04/09/10 y _ _
GIS ID: 09600114egg '00�77
� - FEE: 25.00
MUNIS APPLICATION# 201000363 EX RATION DATE: 04/09/11
APPLICANT OCATION
NAME: QUALITY PAVING CQ) y $DICT DRIVE
ADDRESS: 194 S.MAIN STREET 12
,AGE UAURICE R JR&MARTHA M
EAST WINDSOR,CT�F0 4 I1DICT DRIVE
r� TH VNDSOR,CT 06074
, �„� ��
PHONE 860-523-4182 yif
WORK DESCRIPTION: DRIV&-rAZY
APPLICANT AGREES TO FURNISH THE TOVg1 O S . r �FND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY��� .'BY MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APB I SILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOT?-- . h TI - RMIT MANUAL.
ISSUED BY DA E NSPECTED INSPECTED BY
4/9/201011:05AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO. /0000S CONTRACTOR:_ 4 L)a I/ � y
LOCATION: Pdi
TYPE OF WORK: bf\ uJa tJ�
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: 2.�c od�S
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: C^ DATE:_
W/2007 Town of South Windsor INPSECTION REPORT 07
aoryoo 3 APPLICATION FOR STREET EXCAVATION PERMIT 66C,55
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT ,fib
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm 0 6j r Phone No. 1 -9 A
Address of firm w e c Zip Code 0&0?s q
Location of proposed work
Describe fully nature of permit requested G
Starting date �'1 • l�( I 0 Approx.time for completion ( < < o
Call Before You Dig No.9-010 /Cd `-1 a 2 Existing Water Supply ublic Water ❑Well
Existing Sewage Service: eWu�bfic Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT 1S A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est.Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est.Patch Cost$
f Est.Curb Replacement ft
f Est.Curb Unit Price$ /ft
3 Est.Curb Cost$
\' Est.Traffic Unit Cost$ /hr
ur Est.Traffic Control$
Amt.of Deposit$
Total Due$
O Cash (ICheck# i-7
Applicant is responsible for contacting Paid By
the Police Dept.and C.B.Y.D.
I 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
PERMITS AS eQTLINE YE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: ly,' q-1 y
Title: �`- � �a-P�S,,�(�!S Driver's License#: (,fig"3 ti k C, 7 3 0
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