HomeMy WebLinkAboutStreet Cut Permits 35 Dawn Drive (2) 1200207 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 10/22/12
GIS ID:26400035 ' -
MUNIS APPLICATION#_201201410- ___ FEE:
,. 0
10/22/13
APPLICANT
NAME: ADVANCED CONSTRJJCTION = LOCATION
ADDRESS: 5 CHESTNUT HILL ROB AIST3RE�S 35 SAWN DRIVE
ER WONG NICHOLAS TAK-YAN&MARY H
STAFFORD, CT 06075 IIAN DRIVE
isle-
PHONE 860-519-8442 A dLUT-H WINDSOR,CT 06074
is ;
WORK DESCRIPTION: INSTIIRI' E
APPLICANT AGREES TO FURNISH THE TOWN QP SOUTH I D C31�"-AMO �F BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN1'E PENSl S IN [1�REb$�fP T FAR MgINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE AR LICANT IS FAMI-E-4 WIT I _ND ydTl gBIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN(�1�SOLTHr1NDSRSTLII SCUT PRIyIIT MANUAL.
ISSUED BY DATE IN P=ECTED INSPECTED BY
10/22/2012 9:39 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: ,a 600?0 CONTRACTOR: AAaoo�d
LOCATION:_ '3 (r\
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: % -/-`i3
INSPECTED BY:-
WORK IN
PROGRESS:_
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C� � DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
____`_ APPLICATION FOR STREET EXCAVATION PERMIT
Appl No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074 -
---- - - - FFF_ -(49r%-nn
Name of Firm A0\J0,Y\C.(�0 CU►�� �. -.nC��q (tnC1 (C. Phone No. b C.,��1'
Address of Firm `�- _Zip Code�_�
(_I•.��`�"(}'��,i� �-1�1��, �G(�C�_ �_��'��,�(� (�\Location of proposed work _ _
Describe fully nature of permit requested. �b�_5 l�ti � �� /�."TV
Starting date 41�1. Approx. time for completion
Call Before You Dig No. .7 Existing Water Supply: ❑ Public Water
❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish
two copies of separate drawing This section to be filled out by
Indicate North Town of South Windsor
fNo.cuts
/ ► Est. Patch Size(s)__y
Est. Pvt. Thickness in.
Est. Patch Unit Price$�__ /sf
f7 __..__.._
Est, Patch Cost$
Est. Curb Replacement
Es'. Curb Unit Price$.��_ _/ft
Est. Curb Cost$
Est. Traffic Unit Cost$
Est. Traffic Control $
Amt.of Deposit$ _
Total Due$
( )
Applicant is responsible for contacting Cash OCheck tf
the Police Dept, and C.B.Y.D. Paid BY
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT-OF BOND REQUIRED AND TO REIMBURSE THETOWN 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 TLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
_ -- ----- - --Title; Date:- -
-
Driver's License f/:
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