HomeMy WebLinkAboutStreet Cut Permits 1540 Sullivan Avenue (2) 1300084 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/06/2013
GIS ID: 87301540eo % - Nk, FEE: 0.00
MUNIS APPLICATION# 201300576 IPIRATION DATE: 05/06/2014
APPLICANT ,f
0F % LOCATION
NAME: EVERGREEN CONSTAtUC-TON Z DDRE ISWSL ,LIVAN AVENUE
ji��
ADDRESS: 39 SULLIVAN ST = JE SOUTH WNDSOR TOWN OF
SPRINGFIELD,MA 01 1SW U ,LIVAN AVENU
%' OU FA-INDSOR, CT 06074
PHONE
WORK DESCRIPTION: REP 94D-9LAPI SIDE DOOR AT TOWN
HALILLA CIGAl
APPLICANT AGREES TO FURNISH THE f- VUOE.SQUTI� AMQT OBND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANC E1SI IIt �TI �TWJORIAINTENANCE OR REPAIR WORK IN
LIGQ
CONNECTION WITH THIS PERMIT AND THNAO NTjS F LIA f W II A W L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN 0 '-0 `I1 WINUSITTT TETIT MANUAL.
ISSUED BY DATE Vt(TED INSPECTED BY
5/6/2013 10:57 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
If f
i
j
i i i-�
�/
40F A,
/ '//-
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: o�y CONTRACTOR: �LQ /teen CoYfi2
LOCATION: 1 ,59t) S i v \ PA\lp r
TYPE OF WORK: I �1 �i q. f�o DDT �' T f�
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:__
WORK IN
PROGRESS' A 9�u®,- 1 ,
i
01111
� '�-=,- �,� ��,b����.�,�.� �.� � 7��,,•. ,dell
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
FE $26.00
Name of Firm �(/ P. � Gflry Phone-No.
Address of-=wm
Location of p q=W work
IJ
Describe fully nature. it
Starting date .3 Appro ..tune for
Cali Before.You Dig.No: - /9 POExisting Water Supply: i Wate Wen
Existing Swap Service- Sewer 0
PLEASE NOTE: THE DEPOSIT FOR,THE PEhMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELMAINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL.COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INMUDING ANY INCREASES IN PATCH AREA,CURB
-LEN(kTH,-TRAFFIC CONTROL AND THE.TOWWO CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITH N A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR:
Stow sketch of proposedwork or hmnWh This aid" be filled out by
two copies of separate bu icale:Norlh : TOM Of Saidh Vfirtdsor
No.cuts
V' Est;Patch. sf sf
Est,PvL TNd wn in.
EsL Patch Unit Price$ 1sf
-Est,Patch frost$
EsL Cunt Rspiaoement ft
4-0
n /L)de-2 EsL Curb Unit Price
Est.Curb Cost;
Fst..Tratfia Unit Cost$ fir
Est:Trafttc Control$
AmL of Deposit$
Total Due; �.
Cash O Check#
Applicant is responsible for contacting Paid By
the Polloe De Pt.and C.B.Y.D.
i AGREE TO FURNISH,TO.THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND RECKARED AND TO REIMBURSE THE
TOWN OF SOUTH.WINDSOR FOR EXPENSES INCURRED 6YTHE TOWN.FOR MAINTENANCE OR REPAIR WORK IN
CONNECT".W THIS PER. THAT I AM FAMILIAR WITH AND WILL ABIDE BY-THE RU.LES.AND REGULATIONS FOR:,
PERMIT O NED IN, E T OF SOUP WINDSOR'S STREET CUT PERMIT MmUAL.
Sig Date, 5 �3 �7
Title: Drlvees:Lioense#:
PLEASE ALLO T LEAST TWO WOR a 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
sbreetf m atton Pertrat 08 REV 10-22-08