HomeMy WebLinkAboutStreet Cut Permit 261 Graham Road 1000080 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
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DATE: 05/11/10 �_ 3 -
GIS ID:37500261
FEE: 25.00
MUNIS APPLICATION# 201000543 � pro� --X IRATION DATE: OS/11/11
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APPLICANT �� LOCATION
NAME: QUALITY PAVING C-Or % 1 GR HAM ROAD
ADDRESS: 194 S.MAIN STREE WAD LYNSEY T
EAST WINDSOR,C 08 SHAM ROAD
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PHONE 860-523-4182 - VINDSOR,CT 06074
WORK DESCRIPTION: DRAW, �t �
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APPLICANT AGREES TO FURNISH THE rQWOSCUST C $ ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANU , GWN3IAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND HItte
I BILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN HE TOWN OFQ_UTI STEEL PIIT MANUAL.
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19-SUED'IJY DATE INSPECTED INSPECTED BY
5/1 1/2010 1 1:04AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT:
PERMIT NO.:1060 0<?D CONTRACTOR: l'lT f 1 `
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LOCATION: . a�f 4f2�_F h-7 m
TYPE OF WORK: j I t,ct
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DATE INSP NEEDED: DATE INSP: , I t o l u
INSPECTED BY:
WORK IN
PROGRESS: �Db. -
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C 0- DATE:
W/2007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT 0000
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1640 SULLIVAN AVENUE Date: S ac1 1<7
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm 4-7 Phone No.
Address of Firm Zip Code 4�0
Location of proposed work c;
Describe fully nature of permit requested _
Starting date sue / Approx.time for completion O
Call Before You Dig No. 2 6.0 90_?(� 174y Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST.OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
i.ENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
\ Est.Curb Replacement ft
Est.Curb Unit Price C /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for tacting .z r Paid By
the Police Dept.and CA.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