HomeMy WebLinkAboutStreet Cut Permits 9999 Dawn Drive (2) 1000154 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER -- STREET CUT PERMIT
DATE: 08/11/10 - -
GIS ID: 26409999 FEE: 25.00
MUMS APPLICATION# 201001032 - JRATION DATE: 08/11/11
APPLICANT, = LOCATION
NAME: COOKER CONSTRUCTt LLB; % RE DXWN 6_RlVE
ADDRESS: 8 EGYPT ROAD SOUTH WINDSOR
SOMERS, CT 06071 — 4� -UL ,IVAN AVE
W ; SPR,CT 060742734
PHONEff
WORK DESCRIPTION: LOCAL 1>�c EC?�SEE A $c "A (IGAWN DR
APPLICANT AGREES TO FURNISH THE TOWOF S£)UTFI�DSO���1M£) 3NT OF IIIOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY ; E8.INCURTt S TH T�4 O vIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE A?P6CAN L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S6U-- WT1 TD R TREE BUT PP MIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
8/11/201012:51PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: ICw �'_ CONTRACTOR: 616yleelel rd115lk
LOCATION: Pal Lod U f l Ue
TYPE OF WORK: �S' J Z
DATE INSP NEEDED: DATE INSP: h Ll'
INSPECTED BY: 1
WORK IN
PROGRESS: ,,47 f T �?2 �lre� -� s � .� . U.o�Ji+ do
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: CIA
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT 10VIV
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: C�
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm b i�T_ t G�if �r>�1a,1 L Phone No.Z 't? 4", -`I z &j53
Address of Firm �� Qvr.��s Zip Code Q
Location of proposed work a -W n
Describe fully nature of permit requested a"e WVrc8Sr° �'LE Zr- /f-1
Starting date Approx.time for completion
Call Before You Dig No. c 61b 336 6 Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
0
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ __/sf
Est.Patch Cost
Est. Curb Replacement ft
Est. Curb Unit Price$ _/ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
i
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.
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 HE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: W1? �b
Title: �7 llll�U(��f 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 11 REV 11-11-113