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HomeMy WebLinkAboutStreet Cut Permits 9999 Evergreen Lane (3) 1000152 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER STREET CUT PERMIT DATE: 08/11/10 -" GIS ID: 31209999 - FEE: 25.00 MUNIS APPLICATION# 201001030A RATION DATE: 08/11/11 am APPLICANT i >LOCATION NAME: COOKER CONSTRUGTTL ,> �� RE � EVERGREEN LANE ADDRESS: 8 EGYPT ROAD 6 T30 SOUTH WINDSOR SOMERS,CT 06071 14 SUJ IIVAN AVE � SOR,CT 060742734 PHONE WORK DESCRIPTION: LOCA R-�A- ? 5 ?I A &VA N(G EVERGREEN LN APPLICANT AGREES TO FURNISH THE TW ©F I,SDRE�MOItNIsOF$OND REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH WINDSOR FOR ANY O 4AINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND THE A3'PLIANTTAILFAITIJ tND)WELL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SCtLTH V�C�ISR �TRET CUT PkMIT MANUAL. ISSUED BY DATE INSPECTED INSPECTED BY 8/11/2010 12:41 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** _" = — al TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: � CONTRACTOR: LOCATION: TYPE OF WORK: E &5& DATE INSP NEEDED: DATE INSP: 71"'9 ( INSPECTED BY: S WORK IN PROGRESS: . SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO AS-BUILT: INPUT: CV0-_ DATE: rul S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION APPLICATION FOR STREET EXCAVATION PERMIT Appl. No, TOWN OF SOUTH WINDSOR Permit No. PUBLIC WORKS DEPARTMENT 1540 SULLIVAN AVENUE Date: 16,6 SOUTH WINDSOR,CT 06074 t" FEE $25.00 Name of Firm 000 br- �An S ✓UAC- lnv► LLL Phone No. - Address of Firm_ F ( Code Location of proposed work Describe fully nature of permit requested © Starting date Approx.time for completion Call Before You Dig No. -k6ln 33DD 73s- Existing Water Supply: ❑ Public Water ❑Well Existing Sewage Service: ❑ Public Sewer ❑ Septic PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR. Show sketch of proposed work or furnish This section to be filled out by two copies of separate drawing Indicate North Town of South Windsor No. cuts 0 Est. Patch Size(s) sf Est. Pvt.Thickness in. Est. Patch Unit Price$ /sf , i I Est. Patch Cost$_____________ Est. Curb Replacement It Est. Curb Unit Price$ /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 Lthe 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 GOTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT P IT MANUAL. Signed: Date: b > J / Title: - ��� � Driver's License#: t!' -*/h! qq& ,7 q� 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