HomeMy WebLinkAboutStreet Cut Permits 71 Quarry Brook Drive (2) 1200112 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/22/12
GIS ID: 74100071 - FEE: 25.00
MUNIS APPLICATION# 201200825 EXPIRATION DATE: 06/22/13
APPLICANT LOCATION
NAME: HOMEOWNER -„ ADDRESS:;; 71 QUARRY BROOK DRIVE
ADDRESS: SOUTH WINDSOR, CT ObEj74 OWNER: PLATTEIS ALAN M&TERESA A
- - 71 QUARRY BROOK DRI
SOUTH WINDSOR, CT 06074
PHONE
WORK DESCRIPTION: REPLAOI 5 O2�6-SIDEWALK PANELS
APPLICANT AGREES TO FURNISH THE TQWXOF,SOUTH WINDSOR-TkE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURIEI BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THEAPPLICANTIS P '-ILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSR'S STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
6/22/201211:46AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: l 001 CONTRACTOR: )�b► Loocj A,.
LOCATION:
TYPE OF WORK: sidococtlic K"v_�
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: f�,b
WORK IN
PROGRESS: ,�
000
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: - DATE: '7
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 $25.00
Name of Firm �49 ram^--�.® L'k.� '�`� Phone No. dz-Ez-- t �o
Address of Firm Zip Code
Location of proposed work o 0
Describe fully nature of permit requested i a
Starting date Approx..time for completion
Call Before You Dig-No. Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST.OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND-THE TOWNS CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
-Show sketch of proposed work or furnish Thil 4EMn toie 'i out by
two copies of separate drawing Irxlicate North Town of.South VAndsor
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ Isf
- Est.Patch Cost S
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit.Cost$ fir
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash { j Check#
Applicant is responsible for contacting Paid By
the Police t.and C.S.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
CONNECTIQN WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL A131DE BY THE RULES AND REGULATIONS FOR
PE MITS INED E TO(11fN OF SOUTH WINDSOITS STREET CUT PERMIT MANUAL.
Sig
ned• Date-,
Title: Driver's License#:
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPUCA710H 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