HomeMy WebLinkAboutStreet Cut Permits 50 High Street (2) 1300031 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 04/04/2013 �/ =„
GIS ID: 42000050ol VOW
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�/ FEE: 25.00
MUNIS APPLICATION# 201300364 i
i ftPIRATION DATE: 04/04/2014
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APPLICANT
j y LOCATION
NAME: ADVANCED CONSTW'-
ADDRESS: 5 CHESTNUT HILL RSA = �DREIIG STREET
STAFFORD CT 0607ff y ER i C� I�UI &
�1 ( ATUS NEEDLE LN
WNW
SI CHAPEL,FL 33543
PHONE 860-519-8442 ,
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WORK DESCRIPTION: INSTIRP;Rj
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APPLICANT AGREES TO FURNISH THE'I)W190 F pUTH p B
OND THE TOWN OF SOUTH WINDSOR FOR ANC EPJNQRiAINTEN�NCE OR REPAIR WORK IUIRED AND TO N
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CONNECTION WITH THIS PERMIT AND TH1PlaA�ISI W W ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O?k%- G pE_ T MANUAL.
ISSUED BY DA N IED INSPECTED BY
4/4/2013 10:47 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 13 00o -31 CONTRACTOR: 4 d 1 ant-ed Cions" _
LOCATION: so H
TYPE OF WORK: T, s-c, )A kv�lace CAT V
DATE INSP NEEDED: DATE INSP: VA115
INSPECTED BY: f!�
WORK IN
PROGRESS: C&T V SCE
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
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INPUT: �- DATE: Anos,
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
FEEr)$25.00
Name of Firm A0�JW�C.eo �UI�� ��Ci`kVe(( N� `�Cr- Phone No.SLO' CJ
Address of Firm 5 C i- 2P-WW \ 1-O LL 12-60,0 Zip Code
Location of proposed work
Describe fully nature of permit requested 1 A 51 l t\ l i'�P V .6 C-P— C Pr'w
arting date 4 . S Approx. time for completion
Call Before You Dig No. nt`? iG i c�1A S Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing IndicateN Town of North South Windsor
No.cuts
0
Est. Patch Size(s) sf
Est. Pvt. Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
Est. Curb Replacement f�
Est. Curb Unit Price$ /ft
Est. Curb Cost$
--t7 I A, ,
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
CONNECTI WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMIT AS UTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Sign : Date:_ i' rA
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