HomeMy WebLinkAboutStreet Cut Permits 9999 Chapel Road (3) 1200128 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 07/23/12 = ;
GIS ID: 18009999 - FEE: 00
MUNIS APPLICATION# 201200933 > PTgAT1pN_i]ATF
APPLICANT, = LOCATION
NAME: GERBER CONSTRUCTION c6 ADDRESS 9999'CHAPEL ROAD
ADDRESS: 1 NUTMEG DRIVE
6W1ER OWN OF SOUTH WINDSRO
ELLINGTON, CT 06Jki L540UI�LIVAN AVE
SQUTH WINDSOR,CT 06074
PHONE 860-875-6684 ,
WORK DESCRIPTION: IN EWE
I AIN I�GJ PE1,t N➢C ARK
TOWN PROJEG NO FrE,
APPLICANT AGREES TO FURNISH THE TOWN OF"SOUTH WINDSI TT3E AMOUNT OFBOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCfifRI ED-BY-- I E TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH AP1'IICAi*1T IS FAMfLIAR WITH ANTD WUI L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN�4 60-fliI WINDSR'S STREE CUI PERI\ITT MANUAL.
ISSUED B DATE INSPECTED INSPECTED BY
7/23/2012 11:11 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: l d-®a dot CONTRACTOR:
LOCATION: iI n 0' CYIa la �
TYPE OF WORK: 0 h
DATE INSP NEEDED: DATE INSP: i3
INSPECTED BY: /�D
WORK IN
PROGRESS: o / �
6V
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: �3---
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
t640 SULLIVAN AVENUE Date: !9
SOUTH WINDSOR,CT 06074
�1 11 FEE $25.00
Name of Firm-_ _u�QS' COM4TU'Jun _v(_ • _ ---- ---Phone No. —2975-(o&?L4
Address of Firm 1 AJ2±d344 Q,i✓_0_ IS I/I n awn Zip Code L'2 62!j
Location of proposed work Fr,M - :L& f C&aa 1 aA t Glu rk 4 4y ck l add
Describe fully nature of permit requested :___dL'j�I n� Main .
Starting date_8 r t./l'y Approx.time for completion 03J S
Call Before You Dig No.20tZ 29 C) I 2_I Existing Water Supply: RrPublic Water ❑Well
Existing Sewage Service: (Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL.COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
-Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate.North Town of South Windsor
OA) No.cuts
Est.Patch Sizes) sf
Est.Pvt:Thickness in.
Est.Patch Unit Price
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
O Cash O Check#
Applicant is responsible for contacting Paid By
the Police.Dept.and C.B.YD.
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 AS OUTLINED THE TO UTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title: Driver's License#: U' 3.3� .7
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