HomeMy WebLinkAboutStreet Cut Permits 136 Quarry Brook Driv (2) 1200208 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 10/22/12
GIS ID: 74100136
MUNIS APPLICATION# 201201412 FEE: 25.00
R,XPIRATION DATE: 10/22/13
APPLICANT LOCATION
NAME: ADVANCED CONSTRIJCTIOIV ` ADIDREa: I36.QURRY BROOK DRIVE
ADDRESS: 5 CHESTNUT HILL R3�A - ER MILLERRAYMOND B&BEVERLY A
STAFFORD, CT 06076 l36°QUARRY BROOK DR
�_ OJTH PHONE 860-519-8442 _ WINDSOR,CT 06074--_ - �--:-
WORK DESCRIPTION: INSTALRE1� CE C �
APPLICANT AGREES TO FURNISH THE 1 OWN OF SOUTH W1N�1 SE1MOUIaIT 01 B4ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPEIE�INCURAE3 BYTI TDWITOR Il+IAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TA--AP3'1,ICAKIT IS IyAI �Wi PSI ANI�WILT ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OP OU-H WINDSR�ST"NEE CUT PERMIT MANUAL.
ISSUED BY DA ' IIVPECMD INSPECTED BY
10/22/2012 9:45 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:-. CONTRACTOR: dYIG f
LOCATION: 14 r_rud 8�_k_ Z13
v
TYPE OF WORK: j I7 -S GZ 4 V Le
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: @,N
WORK IN
PROGRESS: �_- 7`� l
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:_/ j
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 A0\JaY1 C.C,0 Cv'1 �. �
1 Phone No. CIA_I A �1 4LA Z
Address of Firm `S �� 12GGtC � �,,� ,�
Location of proposed work - -�—��-` —Zip Code
Describe fully nature of permit requested__ iV 1-61, �2.e Cu
,�1-lam/ lnn i� �
Starting date Approx, tune for completion
Call Before You Dig No._ pja �a 15 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
No.cuts
Est. Patch Size(s)-____ ` _ "sf
Est. Pvt. Thickness__in.
c9
Est. Patch Unit Price
Est. Patch Cost
Est. Curb Replacement
Es'. Curb Unit Price
Est. Curb Cost
Est. Traffic Unit Cost$
-- Est. Traffic Control$
Amt. of Deposit$
Total Due$
( ) ( )
Applicant is responsible for contacting Cash Check it
the Police Dept. and C.B.Y.D. Paid B
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 VITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL. ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS UT INED IN THE TOWN OF SOUTH WINDSOR'S STREET CU1"PERMIT MANUAL.
Signed:_
Title:
_.. ------ _---___ —__ Date:___-
_ _ ._
----" — Driver's License//:
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OF
WORK MAY NOT BEGIN UNTIL. A PERMIT HAS BEEN ISSUED MIT
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES