HomeMy WebLinkAboutStreet Cut Permits 68 Bourbon Street (3) 1200183 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/21/12 ;
GIS ID: 12300068
FEE: 25.00
EXPIRATION DATE: 09/21/13
APPLICANT % LOCATION
NAME: ADVANCED CONSTRUCTIQN AI51��1 E 6 130>JRBON STREET
ADDRESS: 5 CHESTNUT HILL P, �&n = OWNER STEAD IELVIN C&EDITH C
STAFFORD,CT 060
_�7
7 t 6&IiJIBON STREET
pi OiITH WINDSOR,CT 06074
PHONE 860-519-8442sf
WORK DESCRIPTION: INSTAL .REPACE /
APPLICANT AGREES TO FURNISH THE TOWN OF S°OUII4 INDSOR It3AM0UNi OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYOUPEISISES INkTkRE17$ � I:E TOWN FOR IYfAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE ARP 114 ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOI ITH WiNDSR ST icuTPERMTT MANUAL.
ISSUED BY DATE INgECD INSPECTED BY
9/21/2012 2:41 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: Ja (--)O l ; CONTRACTOR: fl d u4 o ce® &r's
LOCATION:_(_o A� �
TYPE OF WORK:
DATA' INSP NEEDED: DATE INSP:
INSPECTED BY: C3Z
WORK IN
PROGRESS: if
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:- DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
t
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
r 1— At r- Art
Name of Firm AQQW(, CP—D C0l`>>. EA,10WOr«G R�- Phone No. C CS`C�' 2��Z
Address of Firm I 5 (i`1v\ 1 �( �2bG,,C J Zip Code
Location of proposed work n -n
Describe fully nature of permit requested V)5Ta Q n C/-�-TV
Starting date a Approx. time for completion
Call Before You D g No. �26 o �2877 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.
g Est. Patch Unit Price$ /sf
�` !! Est. Patch Cost$
Est. Curb Replacement ft
l
Est. Curb Unit Price$ /ft
Est. Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control $
Arnt.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
CONNECTI ITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS SOU LINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:. Date:_9i
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