HomeMy WebLinkAboutStreet Cut Permits 189 Skyline Drive (2) 1200165 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 0&30L12
GIS ID: 83100189 = FEE: 25.00
MUNIS APPLICATION# 201201121 = I}XPIRATION DATE: 08/30/13
APPLICANT = LOCATION
NAME: QUALITY PAVING CCU 'o, logAT3Tfftl RS: i$9K1'LINE DRIVE
ADDRESS: 194 S.MAIN STREET �yNER KRAN BHARAT
EAST WINDSOR,CT 06fT88 f$�SKYLINE DRIVE
st SOUTH fINDSOR,CT 06074
PHONE 860-523-4182
WORK DESCRIPTION: DRAEyVAY
APPLICANT AGREES TO FURNISH THE f OWN OF 0-
SOUTH 1NDSflR I}E=AMOUNT£3F BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY - 64 ES f0-V ED$Y THE TOWN FCR N1%f,AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TIDE APPI,ICAI�T IS F-RIz�f 6f- WITH AN- WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOFfTf3 WINDSR'S,STI ty�JTf'ERMTT MANUAL.
iA-
ISSUED BY DATE INPEC I' D INSPECTED BY
8/30/2012 8:49 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: w? Df 6_ ,S CONTRACTOR:
LOCATION:_ 6 Ne
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 1 - 27 -l3
INSPECTED BY:_� _
WORK IN
PROGRESS: -eload')h
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ & DATE:
S/FORMS/TOWN OF SOUTM WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
Name of Firm .-Z 3 �l PZ
_��'� Phone No.
Address of Firm LtJ Zip Code Q O
Location of proposed work '
Describe fully�e of permit requested
Starting date rJ z_ Approx.time for completion D
Call Before You Dig No.,4!pf 2- 3 So 0 70 Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH 1S TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
-Show sketch of proposed work or fumish This section to be filled out by
two co ies of eparate drawing Indicate.North Town of South Windsor
No.cuts
DonaldA.DATanzo
182 Carriage Dr /45W Est.Patch Sizes) sf
Manchester, CTo6o4o /D r n(J,�l ( Est.Pvt.Thickness in.
0
f �(
Est.Patch Unit Price
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price_$. fft
Est.Curb Cost
/o $
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
7 Amt-of Deposit$
Total Due S
�i / �_ ( )Cash O Check#
I 7
Applicant is responsible for contacting L Paid By
the Police Dept.and C.B.Y.D.
1 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 WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS PUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERM T MANUAL.
Signed: // Date: ell 2,
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
ctmpt Fxcavation Permit 08 REV 10-22-08