HomeMy WebLinkAboutStreet Cut Permits 43 Oxbow Lane (2) 1200162 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/29/12
GIS ID: 67800043 - FEE 25.00
MUNIS APPLICATION# 201201112 _ - l xnru e-PTn-kT nA•rU.__
APPLICANlf LOCATION
NAME: ADVANCED CONSTR--CTIQN 4T LANE
ADDRESS: 5 CHESTNUT HILL Rb - Q NERD " HASWE L PETER L&
STAFFORD, CT 0607 = 43 EBpW LANE
I3UTH WINDSOR,CT 06074
PHONE 860-519-8442 =
WORK DESCRIPTION: INSULC
REAEV
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTII WIND ---AM F BAND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY� ENSES IN URRF}�1�THE TOWI�I OR IV AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE API LjCA1`IT IS EAMTI EAR WITH AND WTFL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN CSF SOUTH VVII*IDSR S STkEE, CLIT'T Rr ft MANUAL.
1lot I_a;
ISSUED BY DATE INSPECTED INSPECTE1797
8/29/2012 10:56 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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IN
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 0016d- CONTRACTOR:
LOCATION:_. q3 Qx t �.N
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: I
INSPECTED BY: e
WORK IN
PROGRESS:_ CC
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: - - 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 A v W�LP—Q C YY' • OrG ` fO A(h Se(-. Phone No.
Address of Firm `.� C k2 MQ T I-O L(, �?60, T ROC r Zip Code OUlb
Location of proposed work ���✓' L
Describe fully nature of permit requested 1 V)" ICE I\ f P'PW,C-P- T
Starting date / Approx. time for completion
Call Before You Dig No. 1 �yl `�I 6 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
f� Est. Pvt.Thickness in.
- -- - _ i -
Est: Patch Unit Price$
O
Est. Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
1 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 DSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION TH T PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS UTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: 5
Title: Driver's License#:
PLEASE A OW 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