HomeMy WebLinkAboutStreet Cut Permits 9999 Sycamore Road (6) 1000148 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/11/10 -
GIS ID: 88809999 " FEE: 25.00
MUNIS APPLICATION# 201001027RATION DATE: 08/11/11
APPLICANT„ / = ,LOCATION
NAME: COOKER CONSTRUE I LLC -%� AREA = CQMQRE ROAD
ADDRESS: 8 EGYPT ROAD OWR SIJ VINDSOR TOWN OF
SOMERS,CT 06071 1 DUI DIVAN AVE
O J 1114INDSOR,CT 06074
PHONE
WORK DESCRIPTION: LOCAL ND P�E P� £1 AT�iT x 0 SYCAMORE DR
APPLICANT AGREES TO FURNISH THE TC I (7F SOUTH R E AMOUN€OF BbND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY YPEN5-ES TCURRE B fI HF-TOW TO- AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE ALIAIVT,I FA�ARTH-AND LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S(T3TH WIIIDS STREE CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
8/11/201012:20PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1060 /� CONTRACTOR: �� ��� 600s
LOCATION: 5 zl in le Wood
TYPE OF WORK: �,X,�C}S VIJ Ge,
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
} d
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 �Dea�yg
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00 09
Name of Firm `l)��! l !/K3+WufiM LLB Phone No. fib ! — � S��"S`�1�
Address of Firm e0, Zip Code (j
Location of proposed work S a T%T't W d5 3— b TY
Describe fully nature of permit requested CiP a, 005f �J�c c� 7 c`� Pr Ty 7
Starting date Approx.time for completion
Call Before You Dig No. a�j0330b $:I9 Existing Water Supply: El Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
I two copies of separate drawing Indicate North Town of South Windsor
0 No. cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost
j Est. Curb Replacement _ft
Est. Curb Unit Price$ ./ft
I
I
iEst.Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$,
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Paid By
Applicant is responsible for contacting
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 THE TOWN OF SOUTH WINDSOR'S STREET CUT REIRMIT MANUAL.
Signed: Date: 6
Title:_��1/1�G f� kVlf v<AtOof 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