HomeMy WebLinkAboutStreet Cut Permits 250 Benedict Drive (2) 1300235 TOWN OF SOUTH WINDSOR, CT
PENT NUMBER STREET CUT PERMIT
DATE: 09/05/2013
GIS ID: 09600250o, FEE: 25.00
MUNIS APPLICATION# 201301284 - EXPIRATION DATE: 09/05/2014
APPLICANT LOCATION
NAME: AYOTTE BROTHERS SONS GO �C , DRESS 20EIDICT DRIVE
ADDRESS: P O BOX 498 � ' ''
RI HARb THOMAS G&MICHELE Z
SUFFIELD,CT 0607850ENDICT DRIVE
Al
SJVINDSOR,CT 06074
PHONE 860-654-1800 _
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WORK DESCRIPTION:
APPLICANT AGREES TO FURNISH THE TQWISOUTH I9 E1MQ T 6FB( ID REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY E PI#N I SdN �� IHF fS N--F 1IAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI I L 1N�1S Ir4 fl WI �1I WII 1 ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OFSQ'UT- WII D R TR T IyUT�-E-- IT MANUAL.
ISSUED BY DATFINSPVCTED INSPECTED BY
9/5/2013 9:54 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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01
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: a CONTRACTOR: 0T-re.
LOCATION:Q SO 3l en E d i c j b6\)P
TYPE OF WORK: 'Df'\\J P wa�A
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: '� S
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: I DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
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 $25.00
Name of Firm - (L Phone No.
Address of Firm r- a Zip Code
Location of proposed work o
Describe fully nature of permit requested
Starting date 9- f 3— 13 Approx.time for completion 3 c)kc'
Call Before You Dig No. ,2n► Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CUR"EPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
Est.Pvt.Thickness in.
Est. Patch Unit Price
Est.Patch Cost$
r
Est.Curb Replacement- ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
7 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 WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS S OUTLINED IN THE TOWN OF SOUTHWINDSOR'S STREET CUT PERMIT MANUAL.
Signe - ilC�2 � Date: C?-ddL-12
Title: �'�-4�( t�Y1 -C�— Driver's License#:�2y �
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