HomeMy WebLinkAboutStreet Cut public utility 58 Norton Lane 1100005%('�) TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBERIN .. STREET CUT PUBLIC UTILITY
DATE. 01/20/11
GIS ID: 64800058 y may'h s ' FEE: 00
MUNIS APPLICATION# 201100057 � �� VIRATION DATE:
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APPLICAN P WOMINLOCATION
NAME. CONNECTICUT WAT O�I `__NOWTON LANE
ADDRESS�C i25 NORTH ROAD
STY KEVIN&
EAST WINDSOR,CT 0 8 �N N LANE
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} —00IINDSOR,CT 06074
PHONE c>I $60-¢ 3 3�355 . _'
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WORK DESCRIPTION: !' EXCV �AI v s ECY REPAIR
APPLICANT AGREES TO FURNISH THE Vk I 0AVT� � � BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN?- C T= .MAINTENANCE OR REPAIR WORK IN
CON IECTIQN WITH TJUS.PERMIT AND THE P I A L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTI;INED IN THE TOWN OF SZ' S T ���P IT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
1/20/2011:2:00PM' i`='PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I or�D�,S� CONTRACTOR: C l�
LOCATION: S �d� � ne
TYPE OF WORK: VY) `{ .yl /t2.
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: f�D
WORK IN
PROGRESS: Q C c,* mc,_� 4-o CLPna.d r
L-) C n c4-c 'Tc VV% n 95ACImo_
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: vi
11
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
Jan, 20, 2011 10:39AM CT Water Northern Region No. 8765 P. 1
APPLICATION FOR STREET acAvATION PERMIT
Appl, No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIQWOAK$DEPARTMENT
1640 SULLIVAN AVENUE Data:
SOUTH WINDSOR,CT 06074
FEE $26.00
Name of Firm �oti'niccrlt�r I•r4" Co . Phone No, R66 ,CZ 3 -3355' x_ 33oI
Address of Firm S-Alaiath Rena ,�.vsr tr/�'iv��se2 cT. zip Cade a4
Location of wposed work 58 A44 r o y 4,wgg
Describe fully nature of permit requested ,9XcarrAMe ro, IzeORA e /�.QiAv
r
Starting date 4LIZ 20/ Approx.time for,completion 7
Call Before You Dig No. 2a/!D yid , Exlsling Water.Supply: 04 Public Water 0 Well
ExIi0g Sewage Servioe; ❑Publlo Sewer [�Septto
PLEASE NOTE; THE DEPOSIT FOR THE PERMANENT PAVEMENT.PATCH AND CUR13 FIEPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT Is RESPCNSIRLL 150E THE FULL FINAL COST OF THE
•PEFIMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCRISASES IN PATCH AREA,CURPI
LENQTH;T'RAPFIC.CONTROL AND THE TOWN%CONTROT COSTS. THE PI=RMANEN7'PATCH IS TYPICALLY
COMPLETER WITHIN A VeAR OFTHE TEMPORARY PATCIJ BUT IT COULD•BE LATER THAN A YEAR.
•Show sketoh o proposed work or fumish Thle.sy6don to"be filled olit by
two Copies of separate drawing Indicate Narth T'awn Of Sooulh.Wladsar.
No.cuts
Est.Patch Slze(s) . sl
r. - d I fret.Pvt.Thlolwess Ia.
0 r� Est.Patch Unit Pdoe
A
T o 4t.Patch Cost s.
Al. Est.Curb Reptacemant tl
Sat.Curb Unit
Eft Curb Coet"$
Al
Est,Trafttc Unit Cost$.�.Jhr
Est,TtaHtc Control 6
Amt.of peposlt S
Total Due$' `
( }Cash ( )CheCk#
Appllo6nt is responslble_ r contauUng Paid By
.the Pallce,t3e t.and G. Y.D. •
•1 AOREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN OF SOUTH,W INDSOR FOR ANY EXPENSES INCURRED BY ME TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTIQN WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE 3ULES AND REGULATIONS FOR
PBRMIfS AS OUTLINED It,THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed�� �� Date' /'12ZQ zap
TRIO; l Q itA,T-/a/v S d'�fLcti�i_Sa2 . DrivaeiUoense#_ -
PLEASE ALLOW AT I,EAST TWO WORKINQ DAYS AFTER APPLICATION FOR ISSUANCE-OF PERMIT
WORK MAY NOT BEGIN UNTIL A PF—RMIT HAS BEEN ISSUED
pERMIT SHALL BE KEPT ON JOBSIT'S AT ALL TIMES
Street ewwatfon PE+'mk 08 REV 16-22-08.