HomeMy WebLinkAboutStreet Cut Permits 108 Hilton Drive (2) 1300165 TOWN OF SOUTH WINDSOR, CT
"PERMIT NUMBER STREET CUT PERMIT
DATE: 07/10/2013 t ,
GIS ID;44100168 "" �� a{ ,� FEE: 25.00
MUNIS APPLICATION# 20130095b � TION DATE: 07/10/2014 IRAT
APPLICANT � ' 5s LOCATION
DRIVE
ADDRESS: P O BOX 71 �`< 3 <; E1 � I= AIN1✓ LY EILEEN M
SOUTH WINDSOR, 1vON DRIVE
zV-INDSOR,CT 06074
PHONE
WORK DESCRIPTION: DRI wzIX
APPLICANT AGREES 5 TO FURNISH THE �.OUT=' x
ccrD REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN � � h4 � VI R . AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND T ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN 0 vul wmI' T MANUAL.
ISSUED BY DATA iIrTS ` ' TED INSPECTED BY
7/10/201311:47AM * PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1 1
- CONTRACTOR: A c o1: '..S 1 he
LOCATION: 10 .,
TYPE OF WORK: Dc'k wa LA
DATE INSP NEEDED. DATE INSP: ®t 1- -f
INSPECTED BY: . 0
WORK IN .
PROGRESS:
SEPTIC TANK PUMPED, SMASHED,FILLED WITNESSED❑ YES ❑ NO
AS-BUILT:
DATE:
S/FOPMS/TOWN OF SOUM WINDSOP INSPECTION
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APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date; 3
SOUTH WINDSOR, CT 06074
FEE $25.00
Name o irm co , -�. one No. `✓ \ - -61 --
Address of Firm �,o . r �o>v��. \�' ov ��. Zip Code
Location of proposed work
Describe sully nature of permit requested \�c�
Starling dale � �o��-� Approx. time for completion `a �, \ 4
Can Before You Dig No. ` ��3`�.`1�4D� Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE, THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, IN6LUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Snow Sketch of proposed work or furnish This s2otlQn e filled out b
iwo copies of separate drawing Indicate North TRwn of South Windsor
No.cuts
Est. Patch Size(s) si
,a3 Est. Pvt. Thickness in.
'Est. Patch Uhtt.Prfce$ rs{
I Est. Patch Cost
b' Est, Curb Replacement !t
Est, Curb Unit Price$ /It
Est, Curb Cost $
Est.Traffic Unit Cost$ /hr
Est.Traffic Control $
Amt. of Deposll$
Total Due$
( ) Cash { )Check
Applicant is responsible for contacting Paid By
the Police Dept. and C•B.Y.D.
t AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE TH>
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
PERMI UTLINED IN THE TOWN OF SOUTH WWD50R'S STREET CUT P RMIT MANUAL.
Signed ��7� '� _ Dale;
T;ue 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
Sueec Excavation Permit 08 REV 10.22.08