HomeMy WebLinkAboutStreet Cut Permits 21 Farmstead Drive (2) 1200040 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 04/05/12
GIS ID: 31800021 FEE: 25.00
MUNIS APPLICATION# 201200360 - = _ NIRATION DATE: 04/05/13
AN
APPLICANT = ; LOCATION
NAME: QUALITY PAVING C( ADRESs Zi FARMSTEAD DRIVE
ADDRESS: 194 S.MAIN STREET �R BELLOIAY WILLIAM J&AGNES M
EAST WINDSOR, CT! -88 21 FWIWSTEAD DRIVE
All
OCJVINDSOR,CT 06074
PHONE 860-523-4182 _
WORK DESCRIPTION: UV-
DRIVVAh - '
APPLICANT AGREES TO FURNISH THE TOWN DR-SOUTH NI13I T1IE AMOUIIT�E BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANI'=_E 0 NSE NUR D THE TE�WN 1�R M!AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH APPLICANT IS 1 A1vIiT IAR WITH AN WILT,ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S U-TH W SIUS TREET CUT PERIU1IT MANUAL.
ISSUED BY DATE- TED INSPECTED BY
4/5/201210:40AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:__ /61600 VQ CaONTRACinR: W
4-
LOCATION:
TYPE OF WORK:
:DATE INSP NEEDED: DATE INSP: `I — 3
INSPECTED 6Y:
WORK IN
PROGRESS: �U e� �
SEPTIC TANK PUMP_= -
AS-BUILT:
INPUT: . DATE:_
W12007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT /0?
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Dater
SOUTH WINDSOR,CT 06074
FEE $25.0.0
Name of firm Phone'No. Z
Address of firm aaj"' GC/ Zip CodeloC�
Location of proposed work
� f
Describe#ally nature of.permit req ested
Starting date Approx.timefor completion cs c(at
Call Before You Di No...7O Existing Water Supply: E Public Water ❑Weli
Existing Sewage Service: OPublic Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE: THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST F THE
PERMANENT PATCH AND CURB REPLACEMENT_,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of work or furnish
proposed This section to be filled out by
two copies of separate drawing indicate North Town of South Windsor
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
p Est.Patch Unit Price$ /sf
< Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost.$ /tir
Est.Traffic Control$
Amt.of Deposit$
Total Due$
Applicant is responsible for contacting Paid By
*"e-Rdise Dept—a -C�ct v n.
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 IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: f Date:
Title: La 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.REV.10-22-08