HomeMy WebLinkAboutStreet Cut Permits 479 Pleasant Valley R 1100137 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/13/11 - ` -
GIS ID: 72900479 FEE: 25.00
MUNIS APPLICATION# 201101030 „ EXPIRATION DATE: 09/12/12
APPLICANT „ LOCATION
NAME: HOMEOWNER A.DDRES-- 479 PLBASANT VALLEY ROAD
ADDRESS: SOUTH WINDSOR,CT 06fl74 ER
BREN RICHARD J
479 PLEASANT VALLEY RD
WINDSOR,CT 06074
PHONE
WORK DESCRIPTION: REPAI RDRIV AY APRON ;
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH W-NDSO}R T�1E-AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN E PENES IN�(JRRED.BY TIME"TOWN FORMAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE A ' Ll-CANTJ$FAMILIAR WITH M- WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF"SOi7TFI W-ij1 8R'S TREE f C IJ I P1 RMIT MANUAL.
ISSUED BY DAT INSPECTED INSPECTED BY
9/13/201111:46AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: N►me one I'`
LOCATION: q -1 9 I �C�$Q►7 `I �'
TYPE OF WORK: 1( r\
DATE INSP NEEDED: DATE INSP: h-
INSPECTED BY: G D
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: Cam. DATE:___
W12007 Town of South Windsor INPSECHON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
Appi.No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT /
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm Phone No. 6 0 ^C? �3 _ —3
Address of Firm 4
A, Zip Code 6) Con
Location of proposed work
Describe fully nature of permit requested 2 , g_
Starting date q ( / f Approx.time for completion q J Z
Call Before You Dig-No. Existing Water Supply: Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE.FOR THE FULL FINAL COST.OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND-THE TOWN'$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
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
'1 Est.Curb Unit Price$ !ft
COO Est.Curb Cost$
Est.Traffic Unk.Cost$ fir
Est.Traffic Control$
Z A Amt.of.Deposit S
y; (3 , ,L
Total Due$
O
Cash Check#
t )
Applicant is responsible for oontacti Paid By
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
CONNECTI WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMIT OUTLINED IN THE W N OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL
Signed: Date:
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 PEV 10-22-08