HomeMy WebLinkAboutStreet Cut Permits 171 Commerce Way (2) 1300091 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
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STREET CUT PERMIT
wo DATE: 05/15/2013vag
GIS ID:22500171 FEE:
MUMS APPLICATION# 201300615 - / 25.00 M
MXPIRATION DATE:
05/15/2014
`0 E , LOCATION
APPLICAN
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NAME: ADVANCED CONSTR-C. I Nam/
j ,D I7IOIyIMERCE WAY
ADDRESS: 5 CHESTNUT HILL Ir
% 1E REAL 40UP LLC THE
STAFFORD CT 0601%
�_ AII)%PELT HILL RD
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� fN O` CT 06095
PHONE 860-519-8442 '
WORK DESCRIPTION: INSrhkrj P E
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APPLICANT AGREES TO FURNISH THE p ,SQUTH AM� T } g ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN EPISLII f� T,` -
CONNECTION WITH THIS PERMIT AND TH I Q- I mfwja � �R GIAINTENANCE OR REPAIR WORK IN
CONNECTION WL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN Of�OIlvw
W4LS1 � IT GHTIT MANUAL.
ISSUED BY ED INSPECTED BY
5/15/2013 10:50 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /3 DOo 9l CONTRACTOR: /e�X ��►�a 57)c.
LOCATION:_ w
TYPE OF WORK: 1 .t'fr 1 I e✓J � �
DATE INSP NEEDED: DATE INSP: , a
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: L DATE:_ �- /7-
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
FEnEp$25.00 ccnn cc
Name of Firm r'E�UaN \bP-0 CDI'>> 0)CA�kW(t0(� `�C�. Phone No.
Address of Firm `� C S� (W T 1-��LC NGt Zip Code (U
Location of proposed work 2 ccc_ 'v✓�x
Describe fully nature of permit requested V 5Ta k— C/�'i V
Starting date :4 1 Oils Approx. time for completion 2n
Call Before You Dig No. n`3 �'j Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
—7 Est. Pvt. Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /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.
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 ]1-116 PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLaEDTHE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: �/ 3
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
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