HomeMy WebLinkAboutStreet Cut Permits 428 Pleasant Valley R (2) 1200129 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 07/27/12 % =:
GIS ID: 72900428 %` `5 FEE: 25.00
MUNIS APPLICATION# 201200975
er� vYPIRATION DATE: 07/27/13
APPLICANTIy/ - LOCATION
NAME: H W LEVACK CO. s i$R WgLSANT VALLEY ROAD
ADDRESS: 452 MAIN STREET 1 / j- i MLOI1ORDUZ KATHY&
SOUTH WINDSOR,Cf7 g % =y�} $ SANT VALLEY RD
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R-113 VINDSOR CT 06074
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PHONEAN
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WORK DESCRIPTION: WATR S $ 'IT
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APPLICANT AGREES TO FURNISH THE`1WI SC AM61T OF BOLD REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AI YSI S IN I�TQ�I*fi INTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THLC Al\-1 -S VITII NDILABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINEDIN THE TOWN O MANUAL.
ISSUED BY = INSPECTED BY
7/27/20I28:41AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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a la oo 9 7s APPLICATION FOR STREET EXCAVATION PERMIT a oo la 9
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1640 SULLIVAN AVENUE bate:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm /'�/ �1�iq�'/C' �� Phone No.
Address of Firm �1�' Y�l ,�itz f�t�,/Z� Zip Code
Location of proposed work
Describe fully nature of permit requested
Starting date "t' Approx.time for completion
Call Before You Dig No. > O S` Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT_ COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est.Patch Sizes) sf
lam/ ilk Est.Pvt.Thickness in.
7 Est.Patch Unit Price$ ZS /sf
Est.Patch Cost$ '3 2!
Est.Curb Replacement ft
p Est.Curb Unit Price$ /ft
r Est.Curb Cost$
Est.Traffic Unit Cost$ /itr
Est.Traffic Control$
) Amt.of Deposit$ o S
Total Due$ ��
( )Cash (/Check#
Applicant is responsible for contacting Paid By V 4-4A
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 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 A 'O T INED THE TOWN7 SOUTH WINDSOR'S STREET CUT
-*PERMIT MANUAL.
Signed: Date: / � !� ��r �"
Title: ?��. '� Driver's License#: o �l � T 12
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
MEMO IN
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 2>
WORK IN pr
PROGRESS: Coy 'u t �`' �►a M�. /�S Se `7 t cc.
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES D NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION