HomeMy WebLinkAboutStreet Cut Permits 56 Quarry Brook Drive 1200114 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/22/12
GIS ID: 74100056 FEE: 25.00
MUNIS APPLICATION# 201200828 - EXPIRATION DATE: 06/22/13
APPLICANT = " LOCATION
NAME: HOMEOWNER ADDRESS:. 56 QUARRY BROOK DRIVE
ADDRESS: SOUTH WINDSOR,CT 7-4 OWNER: CLAPPER ROBERT A&KATHLEEN M
" 56 QUARRY BROOK DR
SOUTH ArINDSOR, CT 06074
PHONE
WORK DESCRIPTION: REPAIR AND REPLACE 2 SIDEWALK PANELS
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTHWINDSOR THE'AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY XP EENSES INCURRED BY THE TOWN FOR MIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THRAPPLCANT IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WI"NDSR'S STREET CUT PERMIIT MANUAL.
h
ISSUED BY DATMINV5CTED INSPECTED BY
6/22/20123:17PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I o2 CONTRACTOR:
LOCATION: 6 DQ'q cc y -I o0
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 6 ka9 /1,2-
INSPECTED BY: p
WORK IN
PROGRESS: rtwo S
w-J k gs-6 qo o 1pl�l mil
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: 7� /•� l �—
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT /dGtDi/
Appl.No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00 GPf`
Name of Firm Ho-m eo w pie r Phone No.
Address of Firm Zip Code
Location of proposed work `J z / c9
Describe fully nature of permit requested
Starting date Approx.time for completion
Cali Before You Dig-No. Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST.OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
-Show sketch of proposed work or furnish This noon to be filled out by
two copies of separate drawing indicate North Towns of South Windsor
. Y�� No.cuts
01 V ,2 Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Prue$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ !ft
Est.Curb Cost$
Est.Traffic Unit Cost$ ihr
Est.Traffic Control$
Amt.*[.Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.B.Y.D.
I AGRE TO FU I H O E T OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN F SOU I F R EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONN TION P IT D THAT t AM FAMILIAR WITH AND.WILL.ABIDE BY THE RULES AND REGULATIONS FOR
PERMI AS TL T N OF WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:,r--
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 Perna 08.REV 10-22-08