HomeMy WebLinkAboutStreet Cut Permits 9999 Hollis Rroad (2) 1100121 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/18/11 _
GIS ID:44409999 js = FEE: 25.00
MUNIS APPLICATION# 201100933 y IRATION DATE: 08/17/12
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APPLICAN --------------
�� LOCATION
NAME: BIRM I CONSTRUCTI O£ � �RE 9 HO LIS ROAD
ADDRESS: 10 RIVERSIDE DRIVE L REALTY INC.
ANSONIA,CT 06401 _ _ ELLIlfGTON ROAD
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%s DSOR,CT 06074
PHONE 203-735-0755 A
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WORK DESCRIPTION: EX
Ct�VAt fERVICES FOR
BiJRH: ACE yECTER
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APPLICANT AGREES TO FURNISH THE JTIT 01*,hQ D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN�IE Y3IC I I�IRAINTENANCE OR REPAIR WORK IN
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CONNECTION WITH THIS PERMIT AND THEl�I� IAR 1 AWL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SQUTI WIDT�� SS �UP1fIT MANUAL
ISSUED BY DATE"I S`PECTED INSPECTED BY
8/18/20113:44PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 00 (d, I CONTRACTOR: /
LOCATION: I l S n
.TYPE OF WORK: &12 y h R 1 V 1 {4r- s
DATE INSP NEEDED: DATE INSP:��'!
INSPECTED BY: go
WORK IN
PROGRESS:_ N Gt' - , , ;,s4„ e-vA SecyJc Qg
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:— 30 �--
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT I 00/a
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: `T' I Co• l 1
SOUTH WINDSOR,CT 06074
QQ FEE $25.00
Name of Firm G�� - 4 onS ��c �- d f\ Corw L.Le— Phone No.
Address of Firm I rI A#:t v4 r j(r eta D r�'w t .4 S an L'T Zip Code O G'410 )
Location of proposed work )E,4;r o.j,. S 1+011 1` iL a.v�A t ILJ.
Describe fully nature of permit requested 4x e.,,. -c TA'S it4,ll�.k a" Of- V,t'<r M.,'n
$•trvI'tti� T—
Starting date `i '�O 1 Approx.time for completion Al o ck6'r 1. toll 4 xc F P«-j;.
Call Before You Dig No. 2o%1 *S400&4vS 2011 40 06,Ig1�Existing Water Supply: ❑ Public Water Wel1
01t 3`1° `fgq Existing Sewage Service: ❑ Public Sewer Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH ANDCURB REPLACEMENT 1 A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,-TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This,section to be filled out by
two copies of separate drawing Indicate.North Town of South Windsor
0 No.cuts
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
�+ r" t nS Est.Patch Unit Price
_ Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price_$_ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police Dept.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.WINDSO O ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS R AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLIN N.TH OWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:_ ) G " Z.U 1 1
Title: L r n^ . 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 i2EV 10-22-08