HomeMy WebLinkAboutStreet Cut Permits 240 Brookfield Street (2) 1200148 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/20/12
GIS ID: 14700240 FEE: 25.00
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APPLICANT;/ = , LOCATION
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NAME: ADVANCED CONSTRFJCTION :� 1�DRESS 240=BR( KFIELD STREET
ADDRESS: 5 CHESTNUT HILL REA D MOHAMMAD&ANEESA
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STAFFORD, CT 06076 = 4 #M)6KFIELD STREET
SOUTH WINDSOR,CT 06074
PHONE 860-519-8442 '
WORK DESCRIPTION: INSTILL
APPLICANT AGREES TO FURNISH THE UTH 1�IsIJSQR TIC AMOUR F#OI�7D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYEXPEN FS IN IIRT2EI?$ ' TE TOW1V I OR 1 IAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPUPANT S FAiVII TA WIT I ANIS WII ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S0UI I WIN]7SR'— TjRE,ETf C_151— ER_MIT MANUAL. /l
ISSUED BY -' DATP;INSPECTED INSPECTED BY
8/20/201211:00AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: lc2®d g CONTRACTOR: _ d mace4 r--at o
LOCATION:_L4 o a a &.eld S 4
TYPE OF WORK:-
DATE INSP NEEDED: DATE INSP: /
INSPECTED BY: �
WORK IN
PROGRESS: `
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: CV— DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
- -- --- - - - ---- FEE -
p$25.OD
Name of Firm AQ vat� .O Colr); E% � L(MG� SEC. Phone No.c Lb- rJ -S 4LA 2
Address of Firm 'S C1-e SInQ V `-k L(, �?-C �j (� �� Zip Code
Location of proposed work 4c) of t'e (cj
Describe fully nature of permit requested V STD
Starting date 9 /I C) Approx. time for completion r7
Call Before You Dig No. 2,-,l 2 e3 S S Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
0
Est. Patch Size(s) sf
Est. Pvt. Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
Z 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 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 UTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:`
Title: Driver's License#: 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