HomeMy WebLinkAboutStreet Cut Permit 81 Farmstead Drive 1000161 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/11/10 _
GIS ID: 31800081 � �
FEE: 25.00
MUMS APPLICATION# 201001040 y� ORATION DATE: 08/11/11
APPLICAN y �� s LOCATION
NAME: M C PAVING AND L LC S TEAD DRIVE
ADDRESS: 437 CAPITOL AVE MENTO CARLOS&MARIA
HARTFORD,CT 061'6 ��ff
TEAD DR
G O SOR CT 137 78 29
PHONE g �_
WORK DESCRIPTION: DRIV
APPLICANT AGREES TO FURNISH THE T = � £F ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY �C .. AINTENANCE OR REPAIR WORK IN
I
CONNECTION WITH THIS PERMIT AND THE LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S S �SciJ'L - IT MANUAL.
D 0 "
ISSUED BY DATE INSPECTED INSPECTED BY
8/11/20103:04PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: Ob0%/ CONTRACTOR:AI C U/Y7
LOCATION: D ra (e-m s 4ea d Der j vie
TYPE OF WORK: ,\ V`e ci
DATE INSP NEEDED: DATE INSP: 0040
INSPECTED BY:
WORK IN
PROGRESS: o� �1�f ®�
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: Lm DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT /Obo/
Appl.No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: z/-0-
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm Me-'. e Phone No. g:ro F JT3- '777 3
Address of Firm:3T_��p t.�►Z Zip Code 6(ale
Location of proposed work R--/ rrgYy++3 re, 12�
Describe fully nature of permit requested r92ot t..j Z r,r g44,-C 2x r s -.i nX� Wllt
Starting date �o Approx time for completion 3o Z44S
Call Before You Dig No. cv 3`e aj Existing Water Supply: 2*Public Water ❑Well
Existing Sewage Service: [tA4ublic Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
q Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement It
�c
Est.Curb-Unit Price$ /ft
Est.Curb Cost$;
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.B.Y.D.
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:4.1 f o
Titles ( w nt y ' ' Driver's License#:_/6111 1 3 9`
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