HomeMy WebLinkAboutStreet Cut Permits 3 Carey Lane (3) 1200182 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/21/12
GIS ID: 16800003 = FEE: 25.00
MUNIS APPLICATION# 201201243 = EXPIRATION DATE:_ _ _- 09/2I/13
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APPLICANT =" = LOCATION
NAME: ADVANCED CONSTRUCTION ADISRESS 3 CRP-Y LANE
ADDRESS: 5 CHESTNUT HILL ROADS 1ERs WONG CHUC TRAN&DOMINIC CHO YAN
STAFFORD, CT 0607 "` 3 GREY LANE
SOUTH WINDSOR,CT 06074
PHONE 860-519-8442
IF
WORK DESCRIPTION: INSTAI,LIZPLAEV "
"
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WINDSOI T 3F AMOt3Ak�f�1'BON REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN(91 NSES i 01 ARID$Y- IE TOW`k-f �M;UNTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THk AL'PLI CAI`IT IS F"Am IAR�CIj ANDVII:T ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OFJSOTJTH 1VIIVDSR SSTEff CTJT PERMIT MANUAL.
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ISSUED BY DAE INSPECTED CTE BY
9/21/2012 2:38 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
JI
TOW
N OF SOUTH WINDS OR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: f 4 jo rl CN C-012 S .
LOCATION: 3
TYPE OF WORK: 1 JI,d ;t l l ('TV
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: r D
WORK IN
PROGRESS:. « �� �� _ <4 c,�61 r,-ell
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: lid DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
Name of Firm AQ'J �Ck—' D ( O'Y; • E Y CG`�W(M(� Phone No. Orb ro Z
Address of Firm `� S��v\ ��«�. iZ6aC S C Zip Code ()�0��.�
Location of proposed work ct Ye
Describe fully nature of permit requested U SiG( P C T-�T
Starting date ,2. Approx. time for completion
Call Before You Dig No. f,j _a(nCQ 9 E`7 5 Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
1
\ Est. Curb Replacement ft
jEst. Curb Unit Price$ /ft
Est. Curb Cost$
--- P�� 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
CONNECT H THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMI AS OUTL ED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL,
Signed: Date: 7
Title: 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
c.,,.--, ;-- no not in In no