HomeMy WebLinkAboutStreet Cut Permits 9999 Berle Road 1300077 TOWN OF SOUTH WINDSOR
PERMIT NUMBER C T
STREET CUT PERMIT
DATE: 05/01/2013 = -
GIS ID: 10209999
MUNIS APPLICATION# 201300554 �� - - FEE: 0.00
�PIRATION DATE: 05/01/2014
APPLICANT=� !�_ ��
NAME: B&W PAVING&LANSCAPfiTG ' S LOCATION
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ADDRESS: P O BOX 70 j�
ADDRES BED E ROAD
MYSTIC, CT 06355E - AWN OF SOUTH WINDSOR
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_ 4 11IVAN AVE
PHONE _ %% - y
1-860-571-9942INI?SR CT 060742734
WORK DESCRIPTION:
MILD
T JRB C-2-C ADJUST
HEIGFTl{� aa � LIRQ'D FOR GRADING
APPLICANT AGREES TO FURNISH THE 14VVL �R SOUS
THE TOWN OF SOUTH WINDSOR FOR ANC�ES0TEN3 Q B( VD REQUIRED AND TO REIMBURSE
CONNECTION WITH THIS PERMIT AND TH&1PIS�F V�IABIDE BY THE RUCE ORLES AND REGU IN
LATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O��OI WIC I�PI R T MANUAL.
ISSUED BY DAED
INSPECTED BY
5/1/20132:43PM ' PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: i 3ooc, 7 CONTRACTOR: i
jr7a
LOCATION: l e
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
—/3—/3
INSPECTED BY:__ ,
WORK IN .
PROGRESS:
SEPTIC TANK PUMPED, SMASHED,FILLED _ WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C` DATE: _
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
D 13 a4SSy APPLICATION FOR STREET EXCAVATION PERMIT /I OV-7 7
Appl.No. - TOWN OF SOUTH WINDSOR Permit No
PUBLIC WORKS DEPARTMENT
160 SULLIVAN AVENUE Date; ,.
SOUTH WINDSOR,CT 06074
FEE $25.00
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Name of Firrttz v rx ._ �a,� rr 'c czs y _F'ltOt18 NC#. 3 i �? 4f F
Address of Ftrnt "IC). �� �Vic: � I ut 5, µ Zip Code �2 �
Location of proposed wo
Desadoe ft*nature of permit
; ,
Starting dates 3 Approx.time for
Call Before You Dig No. „ <sr4o€r Existing Water Sully' ❑Pdak Water Q Well
ExWfV Sewage Serviw.- p Pubk Serer Q Sapw
Pl..EASE NOTE: THE DEPOSIT MR THE PERMANENT PAVEMENT PATCH AID CURB REPLACEMENT IS A
PREL IHARY ESTIMATE THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERM[ANE N T PATCH AND CURB RE PLAI:Ir UE NT;INCLUDING ANY INCRE ASEB IN PATCH AREA,CURB
L EM TK TRAFFIC CONTROL AND THE TOWW'S CONTRACT COSTS. THE;PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY BUT IT COULD BE LATER THAN A YEAR.
Show skew of proposed work or fumfsh
taro copies of separate
No.otsts
Eat.Patch Siza(sj of
Est.Pvt.Thickness in.
Est.Patch thnit Pdoe if Ist
Est.Patch Cost i
Est.Curb Replacement ft
Est.Curb tit Price 6 1f1
Eat.Curb Cost;
Est.Traffic Unit Cost$
EaL Traffic Control
Ault,of Deposit�
Total Due
( )Cash ( )Check
Applicant Is resivreltle for csan(acting Paid By
tits Poke 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.
Signed_ Date s-4 -i-lfk,-I)
Title,• I I 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
Shred Fxcavahlon Pem t#08 PE V 10-22-08