HomeMy WebLinkAboutStreet Cut Permits 25 Evans Crossing (2) 1200237 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 11/27/12 '
GIS ID: 30900025 FEE:
MUNIS APPLICATION# 201201581 = 25.00
ExPIRATION DATE: 11/27/13
APPLICANT LOCATION
NAME: ADVANCED CONSTRUCTIQN ADDRESS �5 hVANS CROSSING
ADDRESS: 5 CHESTNUT HILL ROAI? % OiER NGUYEl JOHN Q&CHRISTINE T
STAFFORD,CT 06076 NS CROSSING
OU T H INDSOR,CT 06074
PHONE 860-519-8442 - = ;
WORK DESCRIPTION: INSTALL REP- CE C i
APPLICANT AGREES TO FURNISH THE%Wm sOU D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPANSES IND ' H TORN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE A -TePPI RANT ISA�VII�I��R WISH AIII)WIhL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF s�J NTREET BUT PER1yIIT MANUAL.
t 1 t ,�,.�
ISSUED BY DATD INPETED INSPECTED BY
11/27/2012 9:18 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /Q 00d 37 CONTRACTOR: Ad Va neleJ CoajV
LOCATION:
TYPE OF WORK: A&wa"_voe
DATE INSP NEEDED: DATE INSP: f
INSPECTED BY:
WORK IN
PROGRESS: C A T c/ L.,�Le5
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 --
FEE $25.00
Naine of ir —
m l Phone No. ,� ��`�'�' 2�� Z
Address of Firm `S _(_l "ji1Q 1 l- �bja_a C(Z (� 7_i Code t^
Location of proposed work�S —` p �--�
Describe fully nature of permit requested T�( T�
Starting date t
Approx. time for completion
Call Before You Dig No. _ ` `� Existing Water Supply:
❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
rtwoh,w sketch of proposed work or furnish
copies of separate drawing This section to be filled out by
Indicate North Town o- South Windsor
No.cutsEst. Patch
Est. Pvt. Thickness in.
( Est. Patch Unit Price
�j _-- — Est. Patch Cost$
Est. Curb Replacement ^ft
Es}. Curb Unit Price
Est. Curb Cost$
Est. Traffic Unit Cost$ /hr
Est. Traffic Control $
Amt.of Deposit$
Total Due$
Applicant is responsible for contacting ( ) Cash OCheck#- __.�"-
the Police Depl. and C.B.Y.D. Paid By _�—
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 WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL.ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLINED N TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:________—__.1._._
----- �. ---------� Date:
Title: ----
�- Driver's License it: _
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