HomeMy WebLinkAboutStreet Cut Permits 20 Pheasant Way (2) 1300094 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT-
DATE: 05/15/2013NMI
GIS ID:71100020 FEE: 25.00
MUNIS APPLICATION# 201300620 � - ft PIRATION DATE: 05/15/2014
APPLICANT T „ LOCATION
NAME: ADVANCED CONSTI ION DRE 20 VHEASANT WAY
ADDRESS: 5 CHESTNUT HILL R =j E� Ins k)HN H&CLAIRE M
STAFFORD,CT 0607 IAANT WAY
, L?V INDSOR CT 06074
PHONE 860-519-8442
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WORK DESCRIPTION: INS I€AL-- REPS G�
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APPLICANT AGREES TO FURNISH THE 1WOI*SOUTIT �E�AMQI D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANE-p5NIS 11TVI9R NTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THPICA ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O �TTi WIIR' I �1T PETIT MANUAL.
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IS E DATA" CTED INSPECTED BY
5/15/2013 11:11 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO..,—]3cao09.4 CONTRACTOR: f1d Lb nth C D os tr.
LOCATION:-
TYPE OF WORK:_ i n
DATE INSP NEEDED. DATE INSP: -/,
INSPECTED :-��
WORK IN
PROGRESS:_
SEPTIC TANK PUMPED, SMASHED,FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT.
INPUT: � `~ DATE--
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
- -- - - --APPLl_CATI-ON-FOR-TREE -EXGAV_ATION-RERULT - - - - - -- ----
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
FErE)r>$25.00 C�
Name of Firm AQ OX (-CD C01 1. C n` F. Phone No.
Address of Firm `� ( I (i`)V 1 L� �OGtC A Fe 0'i Zip Code ()�bl(_(
Location of proposed work
Describe fully nature of permit requested- 1 U'1 S 1�CA, ` cl (.l C� /--�-TV
Starting date Approx. time for completion
Call Before You Dig No. � �`� i4��,1 �9 Existing Water Supply: ❑ Public Water ElWell
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
0 No. cuts
Est. Patch Size(s) sf
Est. Pvt. Thickness in.
Est. Patch Unit Price$ /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 O 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 S H
WI INDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTI TH HIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS S U ED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: ,)J f 3
Title: Driver's License It:
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