HomeMy WebLinkAboutStreet Cut Permits 31 Beldon Road (4) 1300134 TOWN OF SOUTH WINDSOR
PERMIT NUMBER C T
STREET CUT PERMIT
DATE: 06/17/2013
GIS ID: 09300031
MUNIS APPLICATION# 201300824 FEE: 25.00
i EXPIRATION DATE:
%� j _ 06/17/2014
APPLICANT
LOCATION
NAME: LAYDON INDUST] as-a s
ADDRESS: 51 LONGHINI LANE � A �11 BELOON ROAD
NEW HAVEN, CT 00 1
�� E SAIGEl ROBERT C&ANN M
�3"! 11ON ROAD
PHONE ----- '� Tj
INDSOR CT 06074
WORK DESCRIPTION: PERT A LN3=�1�tEMENT RE T S "
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APPLICANT AGREES TO FURNISH THE V�OIx SQUT 'A Q
THE TOWN OF SOUTH WINDSOR FOR AA Eft EAM( T UIRED AND TO REIMBURSE
CONNECTION WITH THIS PERMIT AND THCTE3RIAINTENANCE OR REPAIR WORK IN
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FOR PERMITS AS OUTLINED IN THE TOWN OP*Ov_rW4T3 WL ABIDE BY THE RULES AND REGULATIONS
SIT MANUAL.
ISSUED BY DATEICTED �
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.: /3 CONTRACTOR: L - r
Qjds
LOCATION: n
TYPE OF WORK: gf_ �f 4on for
DATE INSP NEEDED: DATE INSP: i0 A /r
INSPECTED BY: . i3
WORK IN
PROGRESS:_ joa
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT.
INPUT: DATE:
S/FOPMS/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
�ii FEE $25.00
Name of Firm �� Z+tl L',� '��'\ Phone No. Q 51�-QQk"
Address of Firm "3 J-N �—Qd1 4P 0 C. Zip Code C—'(.L Si 9
Location of proposed work ea>
Describe fully nature of permit requestedf
Starting date td `q i 3 Approx. time for completion r Wes._•
Call Before You Dig No. ;1--&cA jjLl, Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
+� Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
A Q Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for con ' Paid By
the Police Dept.and C.B.Y.D.
I AGREE TO FURNIS T THE TOWNIOF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN OF S TH WI So
FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECT IT
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS S LI D THE T OFF SQUTH WINDSOR'S STREET CUT PERMIT jMANUAL.
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