HomeMy WebLinkAboutStreet Cut Permits 5 Sawmill Lane (2) 1300097 TOWN OF SOUTH WINDSOR, CT _
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/15/2013
GIS ID: 80400005 '�i FEE: 25.00
MUNIS APPLICATION# 201300626 - '/ PIRATION DATE: 05/15/2014
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APPLICANT - - LOCATION
NAME: ADVANCED CONSTwS q I(3N i� �RE� 5SAWMILL LANE
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ADDRESS: 5 CHESTNUT HILL 1 !! JE I1AK
IA TERRY F&JANICE A
STAFFORD, CT 060% AWMILL LANE
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PHONE 860-519-8442 = Jl` ;�UVINDSOR,CT 06074
WORK DESCRIPTION: INS'fAUIyP �
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APPLICANT AGREES TO FURNISH THE IVI �F�OUT-I � Ii�AM( �EH3ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANLiPN3EI1FICI3DI TF4QRIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THIPPLCAN -ISITY W L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OFQTFI W11?�1T1F 1 PE IIT MANUAL.
ISS BY DATE- TED INSPECTED BY
5/15/2013 12:02 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 13 UDo R`7 CONTRACTOR: 4d C ov),s`M
LOCATION:_ �„ v ►11 La v\,x-
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:12 - 3
INSPECTED BY: '�
WORK IN
PROGRESS:_ L
SEPTIC TANK PUMPED, SMASHED, FILLED_____ WITNESSED ❑ YES ❑ NO
AS-BUILT;
INPUT. cw\- DATE:_ � )
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
ARP14CATION FOR-STRE-ETEXCAVkTIGN PERMIT --- --
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
FEET>$25.00
Name of Firm t��U�� be—D C01N:;II. EX-M1�C���N YC. Phone No.Sub
Address of Firm `� ( I �' (i`�V` �� 12b�� �tk 0�— Zip Code (�b tiL:�—
Location of proposed work. sacolt,�r'((
Describe fully nature of permit requested ly,15—�01 1L\
Starting date �, Approx. time for completion `�-
Cali Before You Dig No. Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
0
Est. Patch Size(s) sf
Est. Pvt. Thickness in.
Est. Patch Unit Price$ /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 WI SOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH HI PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLI ED 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 BE KEPT ON JOBSITE AT ALL TIMES