HomeMy WebLinkAboutStreet Cut Permits 31 Beldon Road (3) 1300134 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/17/2013
GIS ID: 09300031 % FEE: 25.00
MUNIS APPLICATION# 201300824 � EXPIRATION DATE:z Ad
06/17/2014
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APPLICANT = LOCATION
NAME: LAYDON INDUSTRII LL icy DREG 1� LbON ROAD
ADDRESS: 51 LONGHINI LANE ��� E� gIG ROBERT C&ANN M
NEW HAVEN,CT 06 1
��1 > LdON ROAD
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PHONE � DSOR,CT 06074
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WORK DESCRIPTION: PERIAIEITIV� R'Ticy
APPLICANT AGREES TO FURNISH THE F SC?UII
�� j M&T- ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN LNII 1
MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THICAI� S IF AI .WL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OftOTT�WI1SR3T F IEIT MANUAL.
ISSUED BY DATEINSP CTED INSPECTED BY
6/17/2013 10:53 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:_LiO /3 CONTRACTOR: L
LOCATION:_ n
TYPE OF WORK: P��r ma n-� P�1� n yn b c--
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: i3
WORK IN
PROGRESS:_ Pa cGr 1w -e r,w 7-0 c
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT.
INPUT: v v ` 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 $25.00
Name of Firm ' =f-i 6�A` Phone No. QC23- �
Address of Firm i t1 )-C-,0 / G. Zip Code C-�z'�il
Location of proposed work 3 'Be\ rC-r-N
Describe fully nature of permit requested PQ C r"n t yL::,
Starting date E.G `t Approx.time for completion —•
Call Before You Dig No.tam;;, Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
0
Est.Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
00 Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contac' Paid By
the Police Dept.and C.B.Y.D.
I AGREE TO FURNIS T THE TOWN,'OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN OF S TI WI SOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECT ITH PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS S LI D THE Tr OF S TH 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
Street Excavation Permit 08 REV 10-22-08