HomeMy WebLinkAboutStreet Cut Permits 9999 Quarry Brook Dri (3) 1000150 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/11/10 "
GIS ID: 74109999 - = `" - FEE: 25.00
MUNIS APPLICATION# 201001029 :" RIRATION DATE: 08/11/11
APPLICAnt = LOCATION
NAME: COOKER CONSTRUCT-10 I LLG � RES =,QUARRY�-BROOK DRIVE
ADDRESS: 8 EGYPT ROAD C�WI� �gU-H WINDSOR TOWN OF
SOMERS, CT 06071 _ 154D S -L IV AN AVE
- SOU I WINDSOR,CT 06074
PHONE
WORK DESCRIPTION: LOCA t N� NP�3SI SPJ �P� QI AT$i `A fJI r QUARRY BROOK
APPLICANT AGREES TO FURNISH THE TO1W.VflF SO TROF B6ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN EN ES CU E $ ' H TflWI spf WOMAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE A�PLIANT T EAIIIAR TI AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SC) £TH WIiDSR S BT E CUT PFFIvIIT MANUAL.
ISSUED BY DATE I&SPECTED INSPECTED BY
8/11/201012:26PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: coo/15 0 CONTRACTOR: Coo ('o�S T
LOCATION: Prl. u 6l
TYPE OF WORK: czo
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 4b _
WORK IN
PROGRESS: C
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: �� I
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT ICW1 0
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: 6
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm POOV e " (r/1'ls1w(--VLa Phone No.
Address of Firm d v Zip Code p S Yyo
Location of proposed work r 1 ,177Y d 3'3`(p
Describe fully nature of permit requested &, a1r- S111're Rr
Starting date O Approx.time for completion 6 61h
Call Before You Dig No. -IQI y!?( Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by !
two copies of separate drawing Indicate North Town of South Windsor
No. cuts
0
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf I
Est. Patch Cost$_
Est. Curb Replacement ___ft
Est. Curb Unit Price$ —Ift
I
Est.Curb Cost$ __
I
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$_.
i
Amt.of Deposit$
I
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 IIJWTHE TOWN OF SOUTH WINDSOR'S STREET CUT PE MIT MANUAL.
d: Date: ylq
Signe J/
Title: � Driver's License#: /�19g6 q9�(
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