HomeMy WebLinkAboutStreet Cut Permits 22 Haystack Lane (2) 1300093 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/15/2013 ,
GIS ID: 40500022 =- Arif FEE:
MUMS APPLICATION# 201300618 !/ 25.00
MZA PIRATION DATE: 05/15/2014
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APPLICAN'P = ��
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LOCATION
NAME: ADVANCED CONSTIIIC�IpN / DRE� 2AYTACK LANE
ADDRESS: 5 CHESTNUT HILL Rop
1 STAFFORD, CT 0607 �E % FNETT JOHN J&MARIAN M
2 IAYTACK LANE
INDSOR,CT 06074
PHONE 860-519-8442 i
WORK DESCRIPTION: INSA "t
APPLICANT AGREES TO FURNISH THE IVY-0P SbUT � � AMQ� T pND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN E'g-PEP Iy�C TI
� ` � C3RIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI'iAC WL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN IT MANUAL.
ISSUED B DATII ' CTED INSPECTED BY
5/15/2013 11:03 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: -chbo,/'e� Ga kls`t
LOCATION:_ Tr+� Me-
TYPE OF
DATE INSP NEEDED: DATE INSP: 2 -s-„
INSPECTED BY.-
WORK IN
PROGRESS: A
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT.
INPUT: DATE: a-I e:i Y
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 $25.00 C n
Name of Firm v(a�\L,C�l� C Ott �\1C�`�Q�4� ��1 Phone No.�SL cs 2 4tA 2
Address of Firm S C i-E ���V T 1-k�L( Zip Code
Location of proposed work
Describe fully nature of permit requested V STG I
Starting date `� Approx. time for completion / 2Cz)
Call Before You Dig No. C21 p� Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No. cuts
0
Est. Patch Sizes) _ _____sf
Est. Pvt. Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
—� Est. Curb Replacement ft
Est. Curb Unit Price
'— Est. Curb Cost$_
Est. Traffic Unit Cost$ /hr
Est.Traffic Control $
Arnt. of Deposit$
Total Due
( ) Cash ( ) Check
Applicant is responsible for contacting Paid
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 THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS TLI D IN THE TOWN OF SOUTH 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 RE KEPT ON JOBSITE AT ALL TIMES