HomeMy WebLinkAboutStreet Cut Permits 266 Avery Street (2) 1200238 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 11/27/12
GIS ID: 06300266 = FEE: 25.00
MUNIS APPLICATION# 201201582 E&PIRATION DATE: 11/27/13
LOCATION
NAME: ADVANCED CONSTR(JCTIQN ADDRESS- 2S6 AVIARY STREET
ADDRESS: 5 CHESTNUT HILL RQA p ER = Db-UGLAS EMYLEE
STAFFORD,CT 06076 := 26- STREET
= S(JJJTFI VINDSOR,CT 06074
PHONE 860-519-8442
AF
WORK DESCRIPTION: INSTAL-U- PT.�C�CA31
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WINI 4 T 4MpU17T p "I30- D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN'BXPBISI S INURIb 13IH1 If� N FpR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE NPfcA1tIT IS F Y1vIITY I�I�WITH ANI WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF 6UT-t WINDSR-S 9TRE BUT PER�v IT MANUAL.
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ISSUED BY DATE TED INSPECTED BY
11/27/2012 9:20 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: Z R 00,-23.8 CONTRACTOR: coY5lx .
LOCATION:_ 076L-A y y Zs=i
TYPE OF WORK: �h -,-ja
DATE INSP NEEDED: DATE INSP: 3 - ` 13
INSPECTED BY:-Sn _
WORK IN
PROGRESS: �� S rleey +'►�s �' �r "1'l P��2
Y10� f�— � 1
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ DATE:
SJFORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
App1. No. TOWN OF SOUTH WINDSOR -- 4_..__
PUBLIC WORKS DEPARTMENT Permit No.
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074 `— --
FEE $25.00
L u,'» t. I- A \UPI I)tic IV \U, ` '1 Phone No. &JO VIA 1.3 Z
Address of Firm
f�— 7_i Code �� �
L p Location of pr
oposed oposed work .�Lv
- ,�- �---��
Describe fully nature of permit requested, S k11
Starting date____��— Approx, time for completion
Call Before You Dig No. _ _G
a� _ p �O Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS, THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish __ '—`--- --
two copies of separate drawing This section to be filled out by
Indicate North Town of South Windsor
No.cuts
0
Est. Patch Size(s)_—_ 1—_ sf
Est. Pvt. Thickness_._ _ in.
Est. Patch Unit Price$_ /sf
Est. Patch Cost$
t Est. Curb Replacement ft
Es'. Curb Unit Price$_ _ _ _/ft
Est. Curb Cost$
Est. Traffic Unit Cost$ /hr
Est. Traffic Control$
Amt. of Deposit$
Total Due$
( )Applicant is responsible for contacting Cash ( ) Check tt-`- ------
the Police Dept. and C.BY,D. Paid B
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSORTHE AMOUNT OF BOND REQUIRED -- —
TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK
CONNECTIO THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL.ABIDE BY THE RULES AND RE-GUI ATIONS THE
PERMITS OUTL ED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. IN
CATIONS FOR
Signed.-
---- _ __------- Date:
Title: _ -` ------ —
—' -" Driver's License tt:
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