HomeMy WebLinkAboutStreet Cut Permits 67 Carson Way (3) 1300035 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 04/04/2013 „ %-
GIS ID: 17600067 � �= AQ
�!% - FEE: 25.00
MUNIS APPLICATION# 201300368 i1PIRATION DATE:
/ 04/04/2014
A,I APPLCANL/
�yV& LOCATION
NAME: ADVANCED CONSTI J-CTI I DRE 690AR ON WAY
ADDRESS: 5 CHESTNUT HILL RbA
STAFFORD, CT 0607y � y YJIUl YUAN&
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PHONE 860-519-8442mko
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H WINDSOR CT 06074
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WORK DESCRIPTION: ��
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APPLICANT AGREES TO FURNISH THE W r"TjT �O� D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYF 1 I E
CONNECTION WITH THIS PERMIT AND TH1R1� IS AINTENANCE OR REPAIR WORK IN
ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OI OL wII3I 1 OT I'7y1 IT MANUAL.
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ISSUED BY DACE TED INSPECTED BY
4/4/201311:13AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1 3 66 03,5 CONTRACTOR: ►Ac�y� Camel �c�►n S IV<-
LOCATION: (0. 7 Ca,,c So rn ioa
TYPE OF WORK: 75_� ca (a o�e_ C ATV
DATE INSP NEEDED: DATE INSP: /'?
INSPECTED BY: 9,b
WORK IN
PROGRESS: C'/� 7-
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
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INPUT: L 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 T C 06074
FEEpp$25.00 0o
Name of Firm �v� �� �QI�� EAA V C ACSer• Phone No.
Address of Firm C7� Zip Code 0 ����
Location of proposed work
Des ribe fully nature of permit requested 1 A S 1a(� �'p?C6 C-p- C{ATV
Starting date Approx.time for completion
Call Before You Dig No.
r 1,; _ ifs Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
Est. Pvt. Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
Est. Curb Cost$
Est. Traffic Unit Cost$ /hr
fur S�,r, V-I�«16 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
CONNECTIO THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS OUTLI ED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: C�TJ
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
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