HomeMy WebLinkAboutStreet Cut Permits 590 Chapel Road (2) 1200218 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 11/05/12
GIS ID: 18000590 FEE: .00
MUNIS APPLICATION# 201201481 E EXPIRATION DATE:
APPLICANT.' " - = LOCATION
NAME: METROPOLITAN DISTRICTDRES 590" HtPEL ROAD
ADDRESS: 125 MAXIM ROAD OG ER ST GLAIR GIAA V
HARTFORD,CT 0611�I _= 590 "CHAPEL ROAD
, OJ WINDSOR, CT 06074
PHONE
WORK DESCRIPTION: INSTALU'ANU 4- ANTS 12 I dG 1 Crt TE NEAR MLTIfII LLE DR
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APPLICANT AGREES TO FURNISH THE TO; TD�Sflii AM0U1 fi O BC3ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANU)(VENSES=INCUR I)$ TI1E TO—�VIt FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APk CANT IS FA WI-3 ND WILL,ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTx WINDSR'-S ST REE-T CUT-PEI IT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
I1/5/201210:14AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1i 0002 / g CONTRACTOR:
LOCATION:_ 5 q o C h a(A-0 (Zp Q6a
TYPE OF WORK:__n5 1 I Al Lhgr 4k /0 j rek qa 4e heac M Uri"g)1"e �
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: tR
WORK IN
PROGRESS:_ �r
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ ClM DATE:_ Z- 1 I`�
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
THE METROPOLITAN DISTRICT - PAVEMENT'CUT DATE. ./ ")-A �
BILL JOB YES ❑ NO & WO#
3DRESS �9� Cho Q9CA TOWN S -1 IQSO6Q STATE HIGHWAY YES Cl NO I
RAW SKETCH SHO ING LOCATION AND SIZE OF CUTS A CUT MADE IN
CROS SECTION OF PAVEMENT
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STREET BIT. ONC. it/ CONCRETE ❑ PREMIX ❑
E SIDEWALK BIT. GONG. ❑ CONCRETE ❑ FLAG ❑
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CURB BIT, CONG. O CONCRETE ❑ STONE ❑
DRIVEWAY BIT. CONC, 0 CONCRETE ❑
GRASS LOAM &SEED NEEDED YES D NO P
REASON FOR CUT. ru> l�
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NUMBER OF CUTS:_
DATE OF FIRST CUT:_
IS JOB COMPLETED: YES•W�-90❑ -
/ ,rr FOREMAN:
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REPLACEMENT PAVEMENTCID
CONTRACT NO.•
_ I �
BIT. CONC. ❑ CONCRETE ❑ PREMIX ❑
DATE COMPLETED;.
ACCOUNT NUMBER;_ L' ! L Q -r /ti R I I f
CALCULATIONS
¢_ NO
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N OF CuT ITEM# ITEM` ITEM# UE t
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PRESS HARD 3 COPIES PAVING INSP. OPERATIONS UTILITY SERVICES CONTRACTOR
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