HomeMy WebLinkAboutStreet Cut Permits 206 Skyline Drive (2) 1300099 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/15/2013 == = -
GIS ID: 83100206 ==- �/ FEE: 25.00
MUNIS APPLICATION# 201300628 s iam
L PIRATION DATE: 05/15/2014
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APPLICANT = LOCATION
NAME: ADVANCED CONSTL CJ ION D SK LINE DRIVE
ADDRESS: 5 CHESTNUT HILL'��i S I ILI - PAULA P
STAFFORD, CT 060
-� "�( SK ,INE DRIVE
y , % % %if IINDSOR,CT 06074
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PHONE 860-519-8442
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WORK DESCRIPTION: INS'I-A PACE �maw'
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APPLICANT AGREES TO FURNISH THE 10 SOUTH W- E1M9 fi�Q 13 5ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN,L-� I�SU T1 �VNRGIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI;1I 1'I CAN3 5 L�A�A W l ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN 01IJ ice
CfT WI1SR' TP,GtT PEIIT MANUAL.
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ISSUED BY DATEIMPMTED INSPECTED BY
5/15/2013 12:11 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:_,3 OOp qq CONTRACTOR:�4�1 r1a n ce�,� Cov stf.
LOCATION:_p(e S k U t i h e Dr'i y.E
TYPE OF WORK s rc, 1\ r'e�lu c GrpV
DATE INSP NEEDED: DATE INSP: i a- 5
INSPECTED BY:- �3
WORK IN
PROGRESS: U S Vti A
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ lb A- 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 $25.00
Name of Firm A0yW\Ce0 QL'�S i EX,�kW( �ff SIC. Phone No.�S�C
Address of Firm S I- 2��C�1vT lk L(., �?00, K-60-) C'� Zip Code o
Location of proposed work ' .-C nIr'
Describe fully nature of permit requested I! kin( Q n C(ATV
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Starting date i 2T Approx. time for completion
Call Before You Dig No. Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
0 No. cuts
Est. Patch Size(s)!__._ ___sf
Est. Pvt. Thickness in.
Est. Patch Unit Price$ /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.
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 WIT IS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS O LINE IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: T� Date: :��1� �_
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