HomeMy WebLinkAboutStreet Cut Permits 162 Palmer Drive 1200138 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/06/12
FEE:
GIS ID:68400162
25.00
MUNIS APPLICATION# 201201021 ,� ��- j� -� L`1'IRATION DATE: 08/06/13
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APPLICANT = —- _ LOCATION
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NAME: THOMAS LOVETT DP .EXSt�N �� REST 1i2`PALIER DRIVE
ADDRESS: 44 WEST ROAD 3 C GAT LAWRENCE J&CLARE L
ER DRIVE
SOUTH WINDSOR, 7
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=� TII WINDSOR,CT 06074
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PHONE 860-648-1761 -
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WORK DESCRIPTION: CONK I DRAIN TO BACK OF
CAT(- A* � �_
APPLICANT AGREES TO FURNISH THE T�W�fS8O�IT , I0 (� D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANIU " BS I = E R INTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI AIzIf41NT IS = WIAI ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OI��UIVINIC ��'ET MANUAL.
ISSUED BY DA ED INSPE D BY
8/6/201211:29AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1 0 CONTRACTOR: ah�' lZat7e,1se-ajae_
LOCATION: 140e)L 10ae-mmr
TYPE OF WORK: vi q- L 66
DATE INSP NEEDED: DATE INSP: 9l7z4P-
INSPECTED BY: (3T3
WORK IN
PROGRESS: f Co►1neJtc� or
Svc- spa A New
Yo-tA lbf a S �'^� C;r-.,> S�re2T mo�abr�, �nSf� crvc�
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: v DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR P mit No.
PUBLIC WORKS DEPARTMENT 6 .�
1540 SULLIVAN AVENUE Date..
SOUTH WINDSOR,CT 06074
A i FEE $25.00
Name of Firm U ' V''I (vu �3Pu �G
Phone No.
Address of Firm tjvfS t Zip Code__W 14
Location of proposed work u we✓ fr- 4d-
DescVe fully nature of per it requested COAUL Ck- to 00 eC1d C✓S IfFS
Starting date y1i Approx.time for completion
Call Before You Dig No. 1-0 It- 31 Existing Water Supply: &Public Water ❑Well
Existing Sewage Service: ['Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate.North Town of South Windsor
No.cuts
,`�
CUi(�� � Est.Patch Size(s) sf
t7 Est.Pvt.Thickness in.
Est.Patch Unit Price
—� Est.Patch Cost$
1 n Est.Curb Replacement ft
rf"� ICG I/'����ClS tI Est.Curb Unit Price$ /ft
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Est.Curb Cost$
Est.Traffic Unit Cost$ mr
v Est.Traffic Control$
i(
.. Amt.of Deposit$
Total Due$
1
f- �0`1VV'Q V ( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.B.Y.D.
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 WIT IS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS A IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PE MIT 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 REV 10-22-08