HomeMy WebLinkAboutStreet Cut Permits 9999 South Satellite (2) 1200061 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 04/25/12
GIS ID: 99998400 AO
FEE: 25.00
MUNIS APPLICATION# 201200485E 'IRATION DATE: 04/25/13
APPLICANT "-" ; = LOCATION
NAME: HENKELS&MCCOY,I ZG DRES S, 9999`SOUTH SATELLITE ROAD
ADDRESS: 985 JOLLY ROAD = OVER" TOWN O SOUTH WINDSOR
US
BLUEBELL„PA 1942 _; 1�49UL1vIVAN AVE
' 5717TI VINDSOR, CT 06074
PHONE 1-508-987-3977
Jim
WORK DESCRIPTION: REPLAG--ELE-dRIC
APPLICANT AGREES TO FURNISH THE TQW1?I�E SOUTH WII}S#3I IIE AMOUITT QFQ3�1D REQUIRED AND TO REIMBURSE
%THE TOWN OF SOUTH WINDSOR FOR ANI'=EXPE�ISEINCUII DBY THE T6fWN FQR IYAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APi ICA1�T IS FAMII IAI� TH ANI3 WIC ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SflUI IWI1*ITJSR STREETCU3 PERMIT'MANUAL.
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ISSUED BY DATINSPECTED INSPECTED BY
4/25/2012 3:36 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OP SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: pb0( C0NMCr0R: H_6q tQ
LOCATION 4 ,p
it
.'HYPE OF WORIG
:DATE INSP NEEDED: DATEW.--tal
IIVSPf_CTED 6Y:
WORK IN
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED []YES Q NO
'AS-BUILT:
INPUT: Cji DATE: . j y
W12007 Town of South Windsor INPS ON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT �� tX�j
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm_ ENV'1-a 4 `M C e b V -1- r Phone No.-'SO 9- 98 3 9?'7
Address of Firm qQ rCb ERAL k L x FnWh AA.Q o-i-S5go Zip Code
Location of proposed work t
Describe fully nature of permit requestt.ed 1rP�ra�F Fc ECT2'C CAZLr c��►p�z 2nr�D
Starting date_ `/-�s-J2 Approx.time for completion S -j.-/,2
Call Before You Dig No.0,01-.1 IZLO 2jQ Zrl Existing Water Supply: El Public Water El Well
Existing Sewage Service: ❑ Public Sewer [] Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) 300 sf
Est.Pvt.Thickness 4 in.
o �
Est. Patch Unit Price$ ZS. /sf
Est.Patch Cost
Est.Curb Replacement IUf/> ft
CJ0 \ Est.Curb Unit Price$ /ft
i
Est.Curb Cost$
Est.Traffic Unit Cost$ ` /hr
QoA\ T31� Est.Traffic Control$
Amt.of Deposit$ �,e¢
Total Due$ 75 Z5,
( )Cash {Check# I i t:5��
Applicant is responsible for contacting Paid By EJ€!mot �" /Uc(wok•'
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 WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS
.ASS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed ,
:__/.�.� , Date:
Title;_ Driver's License#: )9 9 I-/a 7 �A
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 10-22-08
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