HomeMy WebLinkAboutStreet Cut Permits 24 Rosemary Lane (2) 1300159 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 07/02/2013 �
GIS ID: 77400024 =- FEE: 25.00
MUNIS APPLICATION# 201300927 - % 1PIRATION DATE: 07/02/2014
APPLICANV = LOCATION
NAME: ADVANCED CONSTI ICE I( N DRE$� 7A ROSEMARY LANE
ADDRESS: 5 CHESTNUT HILL RbGNU I - EI j DARGA' I JAMES P&TORI C
MET Aft- f
STAFFORD,CT 0607i ! �4ZEIIARY LANE
o NO
-��NOWTI��WINDSOR,CT 06074
PHONE 860-519-8442
WORK DESCRIPTION: INSTAI-I% KA-PE !� 7
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APPLICANT AGREES TO FURNISH THE"PV"----LO SOUTH I I�59WA-� f M0 OFBQ D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AAWES PS -Nff- $%IAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THKAYR CA2�1F IS /1 WL W L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O WIT W SRA TIC M--T PE I3 IT MANUAL.
ISSUED BY DAT`ETNSP TED INSPECTED BY
7/2/2013 3:31 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: p
CONTRACTOR: 6a t A-e Cee C1�r15
LOCATION: u
TYPE OF WORK: 9 �t I ice!� (',
DATE INSP NEEDED: DAIS IIVSP- 3
INSPECTED BY-,_
WORK IN
PROGRESS: C�j V
Cc ,r�
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 $25.00
Name of Firrn lr'�n r�r�'� (" ,r1 S n Q i'Ae n DA11 Se V Phone No.
Address of Firm S C Zip Code
Location of proposed work
Describe fully nature of permit requested
Starting date Approx. time for completion `2
Call Before You Dig No. Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer
❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No. cuts
0
Est. Patch Size(s) sf
AF
Est. Pvt.Thickness_ _in.
Est. Patch Unit Price$ /sf
Est.Patch Cost$____
Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$
F _ 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 AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: - % V"� Dater
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
Street Excavation Permit 08 REV 10-22-08