HomeMy WebLinkAboutStreet Cut Permits 9999 Sycamore Road (3) 1000148 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
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DATE: 08/11/10
GIS ID: 88809999 FEE: 25.00
MUNIS APPLICATION# 201001027 = 2RATION DATE: 08/11/11
APPLICAN 7 - LOCATION
NAME: COOKER CONSTRUM-5 t0_ ,LC %O RE S SYCAMORE ROAD
ADDRESS: 8 EGYPT ROAD OWIR SC7ITPi WINDSOR TOWN OF
SOMERS,CT 06071 1 Q SUL LIVAN AVE
OIII WINDSOR,CT 06074
PHONE ;
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WORK DESCRIPTION: LOCAL E PF�IA &T A ] G SYCAMORE DR
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APPLICANT AGREES TO FURNISH THE TOWyf�F.SOUTH= IRE AM01NT qF$AND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY RXP NS II_CURfZE H THE��V4 F�ORZVIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE AILICANT"I1AIuIIA I tND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SGI}TH WIfJDS TIEE IT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
8/11/201012:20PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1000 J �� CONTRACTOR: �!a�roz- cans
LOCATION: ,5 �GJ Road
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: Q)
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT /0b6/Vg
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm � NO�L e f r!/ftS i Yl1c,{i� �.� 'L Phone No. l6
Address of Firm e Zip Code
FYI
Location of proposed work S a TT� 353— bT
Describe fully nature of permit requested l o C,A e fj ld eFq ny -5�S�Q `r -,S
Starting date Approx.time for completion 6
Call Before You Dig No. ��j o 3301> glq Existing Water Supply: ❑ Public Water El Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
i
0 No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est.Patch Cost
f Est. Curb Replacement __ft I
Est. Curb Unit Price$ /ft
I
I
Est.Curb Cost$ _
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$, _
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
I
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 S OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT MIT MANUAL.
Signed: Date:
Title: W q c- (,��� 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