HomeMy WebLinkAboutStreet Cut Permits 55 Cody Circle (2) 1300218 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
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DATE: 08/22/2013 - -
GIS ID:21800055 - FEE: 25.00
MUNIS APPLICATION# 201301195 = EXPIRATION DATE: 08/22/2014
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APPLICANT- LOCATION
NAME: ADVANCED CONSTRI JCTI00- DRES IRCLE
ADDRESS: 5 CHESTNUT HILL R�1I5=
!� ER S-XIMSO T SCOTT D&SHARON L
STAFFORD, CT 0607
55 COY CIR
IJH V INDSOR,CT 06074
PHONE 860-519-8442 ,
WORK DESCRIPTION: INST"A13I REWL aw
E C�
APPLICANT AGREES TO FURNISH THE TW1�OF SOUTH=- 1DSQT�M IOFJI�(}E)3Q3VD REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANC 6&ENSES�N �DBY'1HE TOWN Iy�R 1 AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THL PP�AC IT IS 1�A WI AN WI I ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OlbiTTII WINbTREEJ PERI+IIT MANUAL.
ISSUED BY DATE INgPECTED INSPECTED BY
8/22/2013 9:28 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:_A_ C'� )—ram, CONTRACTOR:-. Acl�baej
LOCATION: rO t AC' �� -e
TYPE OF WORK: Coto
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: Fib
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C Vw DATE:_
W12007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
Appi. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm '�r✓7 ("J,r1 E7 n G LAC__ n� fps� Phone No. ��� 5,Cj
Address of Firm Zip Code
Location of proposed work
Describe fully nature of permit requested
Starting date_ $ --'- Approx. time for completion 2�
Call 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
two copies of separate drawing This section to be filled out by
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 _ it
Est. Curb Unit Price$ /ft
Est.Curb Cost$
Est. Traffic Unit Cost
�j Est.Traffic Control$
Amt.of Deposit$
Total Due
( )Cash ( )Check#
Applicant is responsible for contacting Paid B the Police Dept.and C.B.Y.D. y
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.
Signed: AO-A' Ail I Date:- �( 2�
Title:
Driver's License#:
EASE 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 Excavatlon Permit 08 REV 10-22-08