HomeMy WebLinkAboutStreet Cut Permits 21 Grant Road (2) 1300161 TOWN OF SOUTH WINDSOR, CT
-PERMfT-NUMBER _ _ _ _ -STREET CUT PERMIT
DATE: 07/02/2013 W „
GIS ID:37800021 FEE: 25.00
MUNIS APPLICATION# 201300930 E £PIRATION DATE: 07/02/2014
APPLICAN = - - LOCATION
NAME: ADVANCED CONSTP. JC_I DRES� A ORAWT ROAD
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ADDRESS: 5 CHESTNUT HILL R� ��� L�i,ANIIJARED&CYNTHIA
STAFFORD, CT 0607i 2i-bUAI ROAD
% TrV INDSOR, CT06074
PHONE 860-519-8442
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WORK DESCRIPTION: INSTIAAL- P
IRS
APPLICANT AGREES TO FURNISH THE I� WEE SOUTIL IL# AMO I'OF 3 D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN�EPFNI; INI ( N £}R 1AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THAPI'LJ�ANTISAI�WLFA WI7 ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O *6 FfW__S-R'5 R1 T PENT MANUAL.
010 I l a _ s
ISSUED BY DATEINNPMTED INSPECTED BY
7/2/20133:36PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERHIIT NO.: p CONTRACTOR: Ad oa a. d t3nsA2
LOCATION;_ �r -r �,�
TYPE OF Wow.-
DATE INSp NEEDED: DATE INSP: l a
INSPECTM BY: (3�
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:_ aka
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
- - - -- APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No, TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1640 SULLIVAN AVENUE Date;
SOUTH WINDSOR,CT 06074 l
FEE $25.00 /
Name of Firm 4 d 1/A n�j2&L1 C",,►-�S E n c�(Ae� n�Phone No. �1�..� 5 Eel z�
Address of Firm rO 5 C Zip Code
Location of proposed work
Describe fully nature of permit requested
Starting date___Lf i 2a/ Approx, time for completion
Call Before You Dig No. fZn1- -`3zf-fie -8 o Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
p—� Est. Patch Unit Price$ /sf
Est.Patch Cost
Est. Curb Replacement
Est. Curb Unit Price$ /ry
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 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 WINDSOR'S STREET CUT PERMIT MANUAL.
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Signed: /Pa ��V 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
Street Excavation Permit 08 REV 10-22-08