HomeMy WebLinkAboutStreet Cut Permit 31 Chapin street 1000091 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/26/10
GIS ID: 18200031 ��"
al—110FEE: 25.00
MUNIS APPLICATION# 201000628 �y �s y
�� ORATION DATE: 05/26/11
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APPLICAN � 5
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NAME: QUALITY PAVING CG � HAIT STREET
ADDRESS: 194 S.MAIN STREETS
EAST WINDSOR CAW 8 = � fll BRENT A&KIM M
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PHONE 860-523-4182is It J IV�[NDSOR,CT 06074
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WORK DESCRIPTION: y
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APPLICANT AGREES TO FURNISH THE T ft%E k L .ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY� ES ICU _H ( -` AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE t 'I I T I- L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF STIR T_E CiIT P." IT MANUAL.
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ISSUED BY DATE INSPECTED INSPECTED BY
5/26/20101:15PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: S 64900 9/ CONTRACTOR: O&II,tv
LOCATION:` C h
TYPE OF WORK:— F I rLJa
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: �b
WORK IN
PROGRESS:
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑ YES [] NO
AS-BUILT:
INPUT: r v DATE:
W12007 Town of South Windsor INPSECfION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit o.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
5 -3 Y0 9-
Name of Firm l - Phone No. � 7
Address of Firm s " Zip Code 4040ee
Location of proposed work
17
Describe fully nat re of permit requested _ e
�d JAxe 16i e7 2-
tasting date n Approx.time for completion
Call Before You Dig No.201,0 16770eiExisting Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A -
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH 1S TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
!� Est. Patch Size(s) sf
�g Est. Pvt.Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
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Est.Curb Replacement ft
h� f r 2- < -z- Est.Curb Unit.Price$ /ft
�` qY Est.Curb Cost$
L r ! Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
jv Amt.of Deposit$
Total Due$
ldr ( )Cash ( )Check#
/ 1
Applicant is responsible for confac mg 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 OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title:�Qan � e�c..a-(���, 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