HomeMy WebLinkAboutStreet Cut Permits 9999 Fairview Drive (2) 1300078 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/01/2013
GIS ID: 31509999 FEE: 0.00
MUNIS APPLICATION# 201300555 A- L PIRATION DATE: 05/01/2014
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APPLICANTAN , LOCATION
NAME: B&W PAVING&LAN SCAPJ-NG �QDDRES�% VA VI W DRIVE FROM ELLINGTON
ADDRESS: P O BOX 70
WN 4 SOUTH WINDSOR
MYSTIC,CT 06355 4WtTb _,IVAN AVE
R,CT 060742734
PHONE 1-860-571-9942 / ;
7 Awl ;
Will
WORK DESCRIPTION: MILLVv' 2 = 1� SLUR ADJUST
HEIGITFe0I � � AIA REQ'D
APPLICANT AGREES TO FURNISH THE T R OUll ,
WL
��� 0 GEBC1D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANtXk ffflR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THIPAT IS s DWI AEI VT ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN 0FIIfiIP1 RAT MANUAL.
ISSUED BY DAB s ED INSPECTED BY
5/1/20132:53PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WI'NDSOR INSPECTION REPORT
PERMIT NO.:_ e 3400 CONTRACTOR: ° w : - 0 qe
LOCATION: �1i°r �, ^Kn�y1 l I �(1�1 I�� �' lec, v
TYPE OF
DATE INSP NEEDED: DATE INSP: %
lNSPECTED BY: P
WORK IN
. PROGRESS:
SEPTIC TANK PUMPED, SMASHED,FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:
DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
aoi3 oosSS'__ APPLICATION FOR STREET EXCAVATION PERMIT R
AppI. No. - - TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1640 SULLIVAN AVENUE pate:
SOUTH WINDSOR,CT OW4
FEE $26.00
Name of Finn .�.-.-�`'� ���� ����� ������ ,�� �"
Phone No. 1(2
Address of Finn i }S c;OrI i -11 f i, cu'3'�. ,Zo 2 6._ ;
ed
I..ocatlon ttf propos
Dw4rte fully nature of permit retluested `= ,
ft4ttg date - , a 3 Approx.time for
Call Eefore You Dig Na. .2 1.31O 13 B_ Existing Water Supply: ❑Putt Water 0 well
Exiting Sewage Serxice: ❑Pulft Sewer p So*
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PREI.IMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE HALL.S NAL COST€F THE
PERMANENT PATCH AND CURB REPLACEMENT,INCU M M ANY CEASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWNS CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WMTHMN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Sir ski of proparseal want or furnMh This secdw to be
tm tipples of serpara a draty $ gat by
k6calallorth ?=of Sgg&Wnd
No.outs
Eat.Palch Sb* sf
Est.Pxt.Tt*knm in.
Est,Psi tht Price$ Isf
Est.Paton Cost;
Est Cixb Replooe med
EsL Curb Ualt Price a lit
Est.Curti tit;
Est Tralflc Unit Cost fir
Est..Trstilo Control 4
Arm.of Deposit$
Total Due II
( )Cash ( )Check#
Apptiow is responsible for contacting Paid By
the Police Dept.and C.B.X.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 AS W7LINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signe Date r 1
Title: a o 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
Sued Excavation ta,nit 08 REV 10-22.08