HomeMy WebLinkAboutStreet Cut Permits 174 Rosemary Lane (2) 1200236 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 11/27/12
GIS ID: 77400174 -- FEE: 25.00
MUNIS APPLICATION# 201201580 1 PIRATION DATE: 11/27/13
APPLICANT / % LOCATION
NAME: ADVANCED CONST ION ADDRESS 174 ROSEMARY LANE
RUCT
ADDRESS: 5 CHESTNUT HILL R-OAI- 3 E1 TANDYkSAN J
STAFFORD, CT 06076 174 ROSEMARY LANE
= -Y UTU WINDSOR,CT 06074
PHONE 860-519-84421 IF
WORK DESCRIPTION: INSTAIL—ALT ICE Ct-0n.,
APPLICANT AGREES TO FURNISH THE T WI+I OF-SOUTH D S)Jt T 1E'AMOU IT OI O&D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY':-IhENSES JNC I RJ lal TH>;TOWN FOR 9AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THIJ AR-`I ANT--IS AAMJ052i WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH�11�DSR'S�T��T CUT PERMIT MANUAL.
ISSUED BY DATPTED INSPECTED BY /
11/27/2012 9:16 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: a? ? CONTRACTOR:AAC lI cz c®I?3 j__A .
LOCATION: Z'51" M'le�t
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TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 2 Z41113
INSPECTED BY:_
WORK IN
PROGRESS: C 4 / L; rr/=� ram ) 4 t/'� 1 V
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C, _ DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
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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 $25.00
Ua Name of Firm A0n(,P-0 COPY _ O G� `y 1�LpOAG� Phone No.&b- CJ,"
Address of Firm S CI-S1C\Q V 1kku- �?ba Zip Code b
Location of proposed work
Describe fully nature of permit requested
Starting date 11/14 Approx. time for completion (114
Call Before You Dig No._� � Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No. cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
0
Est. Patch Unit Price$ /sf
Est. Patch Cost$
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f
Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
�____..___.__..._.�___-.__.____w-•-_-- Est.Curb Cost$
Est. Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.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
CONNECTION WIT I PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OU INED I THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: /.411
Title: J 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
Street Excavation Permit 08 REV 10-22-Q8
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