HomeMy WebLinkAboutStreet Cut Permits 9999 Beldon Road (2) 1300080 TOWN OF SOUTH WINDSOR, CT
----PERMIT NUMBER - - -- -- - - - ---- - -- -_-STREET CUT PERMIT -
DATE: 05/01/2013 / opa --
GIS ID: 09309999 FEE: 0.00
MUNIS APPLICATION# 201300558 EXPIRATION DATE: 05/01/2014
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APPLICANT LOCATION
NAME: B&W PAVING&LANJSCAPP NG ��DDRES L O RD ELLINGTON RD GOVERNORS
ADDRESS: P O BOX 70 -SOWN(V SOUTH WINDSOR
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MYSTIC, CT 06355 _ �/� ,,- L�,IVAN AVE
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NDSJR,CT 060742734
PHONE 1-860-571-9942 rc
WORK DESCRIPTION: TACK.a a vFRub-A ' I �UZ R3 ADJUST HEIGHT OF
UNDF; iz' � �I FLUSH PAVING
APPLICANT AGREES TO FURNISH THE VWI�IOUIITPpk `�( gqD REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANXV% ___ TIDE 3;p 1 pR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THIN�PLItv AT IS =�W�A ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF IIIR PRT MANUAL.
ISSUED BY DAB _ED INSPECTED BY
5/1/2013 3:44 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 3 DD080 CONTRACTOR: PA.V 1.0 a
LOCATION:
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TYPE OF WORK: -
DATE INSP NEEDED. DATE INSP: ..1 3 r3
INSPECTED BY.-
WORK IN
PROGRESS, R o' a Ac
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: bv�N— DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF`*SOUWWIIW$Ort- --- -- --- Permit NO. _
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE, Rene:
SOUTH WINDSOR,CT 0074
FEE$25.00
Name of Film fa!tl r �uafs � �r , ( -e Phone Na. �4e . - ` �.�
Address of Firm -7 (-ClS � €r � � r a"= .. Code
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Location of proposed
Descift fully nat re of permit retluested 7 * cr �"_ �� -og ,; 4.4
Starting AMrox.time for
Call Before You Rig No.Z o13 t jo t 3-3 o Existing Water Supply ❑Public Water Q won
ExWng Sewage SwAce: Q PW&Sewer p Sef
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESMATE. THE APPUCANT IS RESPONSIBLE FOR THE DULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDM ANY VMEASES IN PATCH AREA,CURB
LENQTK TRAFFIC CONTROL AND THE TOW ICS CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
-Shaw sketch oI prapoaed eroctc or b7fth �
two copies Of Tom of by
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No.outs
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W' a r�0 Est.Pitt.Thkknesa M,
Eat.Pate Unit Pd a !at
EeL Patch Cast>I
Est Curb Replaoen►ent ft
Est.tab Unit Pdoe S I t
Est Curti Cost f
Est.Trams Urit cost
Est.Trait control sL
AmL at Doposlt$
That Due
( )Cash ( )Check#
Applicant is responsible for contacting tac Ling Paid By
the Police Dept.and C.B.Y.D,
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REOUIRED 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 AS OUTLINED IN THE TOWN OF SOUTH WINDSOWS STREET CUT PERMIT MANUAL.
Signed; , /7 Date, �" 1
Title; i j$ 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 JOSSITE AT ALL TIMES
Stx+edExcavation Permit08 REV 10-22-08