HomeMy WebLinkAboutStreet Cut Permits 106 Cornerstone Drive (2) 1300038 TOWN OF SOUTH WINDSOR
PERMIT NUMBER C T
/ STREET CUT PERMIT
DATE: 04/04/2013
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GIS ID:23800106 s
MUNIS APPLICATION# 201300374 ��� � FEE:
25.00
ftPIRATION DATE: 04/04/2014
APPLICAN ,, LOCATION
NAME: ADVANCED CONSTI J�TIq-N '�
ADDRESS: 5 CHESTNUT HILL ROB %�DRECOIkNERSTONE DR
% E - INWARD V&LISA Z
STAFFORD,CT 0607 y / i = y
D eftkERSTONE DR
PHONE 860-519-8442 -- —� INDSOR,CT 06074
WORK DESCRIPTION: INSAL
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APPLICANT AGREES TO FURNISH THE F SOUTH
THE TOWN OF SOUTH WINDSOR FOR AN`�ERP
=� �MQ-U QY B0ND REQUIRED AND TO REIMBURSE
T N OK 4AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THUA1 toc IS ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O1bLITVIIT�
y
F PE13IT MANUAL.
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ISSUED BY
DA M ,ED INSPECTED BY
4/4/2013 12:05 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 3!? CONTRACTOR: M J4r iP CD�n,S
LOCATION: c n t V�e j-"5�J=:c If`►vim
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: �'�� /-:' ,'r��l -r-•al /rsl
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�j$25.00
Name of Firm AO\MY CP—0 ��01'>>1, EX,� V
` � lee(M(vf Phone No.�S�iC c--)A
Address of Firm 5 I������ 1 ��«-�. ��aC �� � Zip Code 0661(r
Location of proposed work
Describ fully nature of permit requested U
i cnrnerctorn —
Starting date � Approx. time for completion )
Call Before You Dig No. —2I 2 Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s)_._ ___sf
Est. Pvt. Thickness in.
Est. Patch Unit Price
Est. Patch Cost
Est. Curb Replacement ft
I
Est. Curb Unit Price
Est. Curb Cost
Est. Traffic Unit Cost$. /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 WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS UT ED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
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