HomeMy WebLinkAboutStreet Cut Permits 63 Timber Trail 1200118 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 07/10/125
GIS ID: 89700063 � ��% FEE: 25.00
MUNIS APPLICATION# 201200895 y EXPIRATION DATE: 07/10/13
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APPLICAN1F 4 ry LOCATION
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NAME: HOMEOWNER j RES% 6 TIMBER TRAIL
ADDRESS: SOUTH WINDSOR CQ7 j' L 1CINEL ,I PETER J&KAREN J
3MMR TRAIL
UUL WINDSOR,CT 06074
PHONE / Ad
WORK DESCRIPTION: REPU-A ,S LI� �A � WAIy
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APPLICANT AGREES TO FURNISH THE I`QWfz�SOUTAMOU CJ3(.AND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN AAV� �`�T} N R M INTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THL1P1> IS Y W A W1 ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OPiI1IUIND
RT I PET MANUAL.
ISSUED BY DA1` ED INSPECTED BY
7/10/20129:44AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: ZQ 60 J CONTRACTOR: /46 meow►'��.
LOCATION: er
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 2f
INSPECTED BY: a r>
WORK IN
PROGRESS: IDttie sjQ i � ��a.�. 2.zo�acec� ;�•,
Me;AA or, -AcK^tss dirk no+- to t"e4z �favC
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617
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No.. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm iv- AA14W I Phone No.
Address of Firm Q 71NK IW)L i ta 4 Zip Code
Location of proposed work M ft(- X 460l E
Describe fully nature of permit requested kE U CC 510E WLK PibCE
Starting date 7 - - M E Approx.time for completion ' �Z-
Call Before You Dig No. Existing Water Supply: Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer t,Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing / Indicate North Town of South Windso
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D�l.C� � s-> NO.CUtS
Est.Patch Sizes) sf
� M Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
_ Est.Patch Cost$
C^` Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
{ Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
C:1 Est.Traffic Control$
2_1
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting " Paid By
the Police De t.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�JDINED OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: /' Date: _ ^ -
Title: V Driver's License#: V` �O�O
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