HomeMy WebLinkAboutStreet Cut Permit 125 High Street 1000160 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/11/10
GIS ID:42000125
FEE: 25.00
MUNIS APPLICATION# 201001039 - TION DATE: 08/11/11
APPLICAN LOCATION
NAME: M C PAVING AND L P mciL' 3 tIIG STREET
ADDRESS: 437 CAPITOL AVE
HARTFORD,CT 061 I s 3z PyT
PHONE C) J +NDSOR,CT 112 63 63
WORK DESCRIPTION: DRIV g=X.
APPLICANT AGREES TO FURNISH THE T F@-
J-1: ;F ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY S C {} AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE - LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S UT IT MANUAL.
Ie 0611eqs.
ISSUED BY DATE INSPECTED INSPECT BY
8/11/20103:02PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
-- ------ .......... -.--------- ..... ----....._.-_..........-- ..._----- ----------- - ......... .......---------- ..-------------------- ....... .--------------------------------
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I 000/�0 CONTRACTOR: I Cpav 1'n
LOCATION:
TYPE OF WORK:_ Dr )\j e LA-9 U
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: f3�J
WORK IN
PROGRESS: e
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C `"" DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT /000160
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
cj S 1540 SULLIVAN AVENUE Date: v 16C o
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm !'kl.cr e";4,4 Phone No.2t sue- V 8 3 - '-7 7?03
Address of Firm C9-»1,11 z H,4Wnvo L4 Zip Code a t<a G
Location of proposed workera6" A11-94C a2
Describe fully nature of permit requested liri1c
Starting date 0 Approx.time for completion 3 a L11 yS
Call Before You Dig No. as 1n 3 l c2)iTS` Existing Water Supply: [}Public Water ❑Well
Existing Sewage Service: [�-Public Sewer: ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING'ANY<INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of propose&work or furnish This section to be filled out
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
v
e Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /it
Est.Curb Cost$
r Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
O Cash O Check#
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 OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: w Date: 1 !11 Zia
Title: Or.,x..e f! 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 Novation Permit`08 REV 10-22-08