HomeMy WebLinkAboutStreet Cut Permits 61 Debbie Drive (2) 1200206 TOWN OF SOUTH WINDSOR, CT
PENT NUMBER STREET CUT PERMIT
DATE: 10/22/12
GIS ID:26700061 _ FEE: 25.00
MUNIS APPLICATION# 201201409 f XP_TR A_T_TClM_IIA_TF
APPLICANT LOCATION
NAME: ADVANCED CONSTRUCTIOS�1 AT515RCRE% 61 D B 3IE DRIVE
ADDRESS: 5 CHESTNUT HILL RM1 ` ER CLYMEI DAVID M&GLORIA G
STAFFORD,CT 0607P „ 61 15EBIE DRIVE
' St��JTH)�- INDSOR,CT 06074
PHONE 860-519-8442
WORK DESCRIPTION: INSfA- LIf R 1�A CE Gt I „
APPLICANT AGREES TO FURNISH THE TO WN OF sbb M W,II*MSOR IE AMOUNT T�F B07VD REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY It NSh5 I wkM$YfiHP TO��OR 1 AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THk AP 6xi4f TS I V4 F AR WITTi AND WIL-ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OFSOIITI WINDSJ3 WSTRI I f`CUT PERMIT MANUAL.
ISSUED BY DATE I ETED INSPECTED BY
10/22/2012 9:34 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I pa CONTRACTOR: Mom yad o o s`r,
LOCATION:_ JAY'\\
TYPE OF WORK: 1 ( M lQ
DATE INSP NEEDED: DATE INSP:42
INSPECTED BY: b2t)
WORK IN
PROGRESS:__ A T✓ e c .Ilea
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:-,,
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
T. APPLICATION FOR STREET EXCAVATIONPERMIT _
Appl. Now TOWN OF SOUTH WINDSOR — ---
PUBLIC WORKS DEPARTMENT Permit No.
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074 —
I=j=-j= 2g-�
0\JaY C.0 O C'o�1�I.
Name of Firm LnG 1�1 y�C1 �C�. I C,'
Address of Firm � (I-t)-1 f W I R LL �baC Phone No. '��C _�7_ip Code
u�� Z
Location of proposed work
Describe
--- —fully nature of permit requested `—
Starting date _
Call Before You Dig No.
Approx. tirne for completion
_ ) � � 9/ Existing Water Supply: ❑ Public Water
❑ Well
Existing Sewage Service: ❑ Public Sewer
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS Septic
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish -~ --
two copies of separate drawing This section to be filled out by
Indicate North Town of South Windsor
No.cuts
0
Est. Patch Sizes)
Est. Pvt. Thickness in.
Est. Patch Unit Price
Est. Patch Cost
Est. Curb Replacement it
Es,'. Curb Unit Price$
Est. Curb Cost$
Est. Traffic Unit Cost$
Est. Traffic Control$
Amt. of Deposit$
Total Due$
( ) (
Applicant is responsible for contacting Cash ) Check#---'.�--------
the Police Dept. and C.B.Y.D. Paid B
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSORTHE AMOUNT OF BOND REQUIRED AND TO
REIMBURSE
_—
TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK
CONNECTIO TH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL.ABIDE BY THE RULES AND REGULATIONS
THE
PERMITSROUTED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. IN
CATIONS FOR
Signed;_
---- -=_-_Tifle: Date:_---
------- 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