HomeMy WebLinkAboutStreet Cut Permits 40 Kennedy Road 1200010 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 03/06/12 _
GIS ID:49800040 s r� FEE: 25.00
MUNIS APPLICATION# 201200209 % q � hPIRATION DATE: 03/06/13
AN
APPLICAN LOCATION
NAME: FOLSOM CONSTRUC IQN L C _N %t&pDRE§ z T EDY ROAD
ADDRESS: 138 RYE STREET i` I SICK F UE LLC
rSOUTH WINDSOR, " �/ DVN ROAD
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I INDSOR CT 06074
PHONE 860-528-8928 - s '
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WORK DESCRIPTION: EXC�Y ' T S EER AND WATER MAIN
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APPLICANT AGREES TO FURNISH TH I S Ufthi O "
� ID REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR $" E LRAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH I k T S w ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O ( i4W C �PE T MANUAL.
ISSUED BY DATPTqSP ED 'INSPECTED BY
3/6/20123:05PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: • ca 06.010 CONTRACTOR: � S''►'`
LOCATION:
'JYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: Ob .
WORK IN
PROGRESS:
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑YES ❑ NO
'AS-BUILT.-
INPUT., Wes. DATE:
W12007 Town of South Windsor INPSEcnoN REPORT 07
Zol2cozog APPLICATION FOR STREET EXCAVATION PERMIT 12aoo1O
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC.WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name one o.
Address of Firm 3 rS � ,� Zip Code_G
Location of proposed work
Describe fully nature of permit requested
Startingdate �' ��
� Approx.time for completion
Call Before You Dig No. O G U Existing Water.Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH;TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH 1S TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
-Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Pate Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price.$. /t
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
AmL of Deposit$
Total Due$
O Cash O Check#
Applicant is responsible for contacting Paid B
the Police Dept.and C.B.Y.D. Y
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 THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS NED ..T T WN OF SOUTH WINDSOR'S STREET CUT PER IT NUAL.
Si d: Date• �' y
Title: Driver's License M -"'�" 3 )0 9 S
PLEASE ALLOW EASQTWO 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