HomeMy WebLinkAboutStreet Cut Permit 285 Graham Road 1000079 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
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DATE: 05/11/10 y ti
GIS ID: 37500285 ��
MUNIS APPLICATION# 201000542 �5y - FEE: 25.00
I'IRATION DATE: 05/11/11
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APPLICAN � �� - �
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NAME: QUALITY PAVING C =RFC � 5 GRAHAM ROAD
ADDRESS: 194 S.MAIN STREE
�57%EW-Mt HERVE A&
EAST WINDSOR,C 10 $S AM ROAD
INDSOR,CT 06074
PHONE 860-523-4182 _� 3 -_
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WORK DESCRIPTION: DRIB -!N.
APPLICANT AGREES TO FURNISH THE � � T C3 E-ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN IS �C. - TfOWI MAINTENANCE�R REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE I�LI Q �LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF J--�T � SST E � P�IT MANUAL.
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ISSUED BY OLDA-`�`-�/�
TE SPECTED INSPECTED BY
5/11/201010:58AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:_
LOCATION: C? ha CYI
TYPE OF WORK: (oau
DATE INSP NEEDED: DATE INSP: L�
INSPECTED BY: B\-
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED -- WITNESSED F1 YES ❑ N0
AS-BUILT:
INPUT: C DATE:
W/2007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT / 0000 79
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
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Name of Firm Phone No.
Address of Firm Zip Code n6 6 ee
Location of proposed work
Des ri fully nature of permit requested 64
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Starting date Approx.time for completion - O
Call Before You ig No. 96 16 2ZZ e Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST.OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN YEAR.
Show sketch of proposed work or furnish This section to be tilled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
/ Est.Curb Replacement ft
Est.Curb Unit Price$ ilt
Est.Curb Cost.$,
Est.Traffic Unit Cost$ /hr
. . Est.Traffic Control$
Amt.of.Deposit$
Total Due$
14
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police Dept.aril 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: 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