HomeMy WebLinkAboutStreet Cut Permits 184 Farnham Road (2) 1100041 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/02/11
GIS ID: 32100184 - FEE: 25.00
MUNIS APPLICATION# 201100385 „ ,EXPIRATION DATE: 05/01/12
APPLICANT ; LOCATION
NAME: LEEBOY PAVEMENrCQMPANX ADDRESS: 184 FARNHAM ROAD
ADDRESS: 60 DICKINSON ROAD OWNER: M ,NNIIG TIMOTHY BERNARD
MARLBOROUGH,CT 66447 184 FARNHAM ROAD
sPaU=-rT-H WINDSOR,CT 06074
PHONE 860-295-9581 - =- -
WORK DESCRIPTION: DRIVEVY
APPLICANT AGREES TO FURNISH THE TOWN OF"SOUTH WINI3SgR THE AMOUNT OF$AND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSE INCUKD BIy TIIE T OWN F(7R=IvIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT IS FAMILIARWIT13 A WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTL INED IN THE TOWN W89 TH,WINDSR'S-STREET CUT PiR-- fIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
5/2/201111:44AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /I boD CONTRACTOR: Zee
LOCATION: R4 Ca 21U
TYPE OF WORK: Dr'1 \, P uj a u
DATE INSP NEEDED: DATE INSP: z /Z_
INSPECTED BY: k i�
WORK IN
PROGRESS: T�) -�-
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES [:] NO
AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
A 011 .)0 5' APPLICATION FOR STREET EXCAVATION PERMIT lrao�y/
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
.1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of FiiL/fNT do . Phone No. 96d • c9 26" - 76-V I
Address of Firm /G Xi�Sdrr X , Ja uG� Zip Code Q4Y y 7
Location of proposed work �2IY f} b .
Describe fully nature of permit requested_ 7w)�N � f ��
Starting date Ij Approx.time for completion
Call Before You Dig o. Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE-,.THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
iLENGTH;TRAFFIC:CONTROL AND THE TOWNS CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
-Show sketch of proposed work or furnish This seetion to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Lfi-, I �-� !ti O� No.cuts
ra.ct.e. Ud wvL, Est.Patch Sizes) sf
Est.PvL Thickness in.
ot
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$
Est:Curb Cost-$
Est.Traffic Unit Cost$ fir
Est.Traffic Control$
Amt.of Deposit$
Total Due$
{ )Cash ( )Check#
Applicant Is responsible for contacting Paid B
the Police t.and C.B.Y.D. 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 AA OUTLINED N IE TDWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed Date: Z11
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