HomeMy WebLinkAboutStreet Cut Permits 223 Brookfield Street (2) 1100148 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/27/11
GIS ID: 14700223 FEE: 25.00
MUNIS APPLICATION# 201101128 EXPIRATION DATE: 09/26/12
APPLICANT _" z LOCATION
NAME: ASPHALT MAINTENANCE PAVING ADDRESS:- 223 BROOKFIELD STREET
ADDRESS: 9 MILLENNIiJM DRIVE = OTTER: INACO 1lfARIA&AMANDIO
CROMWELL,CT 06416 , - 223ROQKFIELD ST
SOUTH WINDSOR,CT 06074
PHONE
WORK DESCRIPTION: REPIACR':EXI$ ING DKiVEWAY
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH W_M_ -- R IE AMOUNT-OF-BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY_EXkPENSES INCURRED BY THE TOWNFOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APft-RANT IS FAMILIAR WITH AND-WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSR'S'STR$$T`CUT-PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
9/27/20113:30PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
- .........
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR,
LOCA7ION:_ 11
TYPE OF WORK.--
DATE INSP NEEDED: DATE INSP:�L
INSPECTED BY:
WORK IN
PROGRESS: a j � Q Lc, k vu
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
'AS-BUILT:
INPUT: Wes, DATE:_
W12007 Town of South Windsor INPSECTION REPORT 07
f
APPLICATION FOR STREET EXCAVATION PERMIT
Appl.No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: i
SOUTH WINDSOR,CT 06074
FEE $25.00
•Name of Firm n .A Phone No. (3- C5 �3 _61 F06
Address of Firm r,, ,`\,C a, LA, C l�l c&4 re U Zip Code 004 t L
Location of proposed work
Describe fully nature of permit requested J=!?401 's_t< y--, yet')
Li
Starting date g2l Approx.time for completionyu.v�C�
Call Before You Dig-No. Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST-OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWNS CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing indicate North Town of South Windsor
0 No.cuts
Est Patch Size(s) sf
- Est:Pvt..Thickness in.
Est.Patch Unit Price$ /sf
Est Patch CostIR
$
Est.Curb Replacement ft
Est.Curb Unit Price$ Ift
Est Curb Cost$
Est.Traffic Unit Cost$ /hr
Est Traffic Control$
Amt of Deposit$
Total Due$
O Cash O 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. IS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLI DIN THE TO� N OF SOUTH WINDSOR'S STREET CUT OPERMIT MANUAL.
Signed: Date; ` b
Title: 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