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HomeMy WebLinkAboutStreet Cut Permits 22 Hearthstone Drive (2) —-------------------------—---- ------------------------ ---- --- --- 1300188 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER STREET CUT PERMIT DATE: 07/23/2013 , GIS ID:41100022 FEE: 25.00 MUNIS APPLICATION# 201301022AV� PIRATION DATE: 07/23/2014 APPLICANT - LOCATION NAME: DEREK CONSTRUCTIO'3N 22 Vt.ATHSTONE DRIVE ADDRESS: 22 HARRINGTONROsD ER BRALLDOUGLAS T BROAD BROOK.CT 06A 22 I R HSTONE-DRIVE— — -- OUT VINDSOR,CT 06074 PHONE 860-623-224840 WORK DESCRIPTION: REPLAC SIDEWAL $ D A AN �i���= APPLICANT AGREES TO FURNISH THE AWN OF S©UTH W W AMOI T OF BON REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH WINDSOR FOR ANC'R 'ENSE INC E TOWFORiINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND TAAPI?LLCAI 1S 'WITICAND WILL BIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN O §(OU-H WIND R t;TR -FT ISL MYI MANUAL. Al ISSUED BY DATE INPCTLD INSPECTED BY 7/23/2013 3:17 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** N-, TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: aD CONTRACTOR: LOCATION: 54(2rC T)/' I TYPE OF WORK: v0a cp bz=AwaAL DATE INSP NEEDED: DATE INSP: INSPECTED BY: WORK IN PROGRESS: env/ca- sVP Vi L� Lfi / fit: L U,4, SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO AS-BUILT: INPUT: DATE: L W/2007 Town of South Windsor INPSECTION REPORT 07 ao/3��raa APPLICATION FOR STREET EXCAVATION PERMIT 1,300188 Appl. No. TOWN OF SOUTH WINDSOR Permit No. PUBLIC.WORKS DEPARTMENT -1540 SULLIVAN AVENUE Date: ? `/ SOUTH WINDSOR,CT 06074 c>a�SS FEE $25.00 b4-1ck 19 sas Name of Firm 1 it 2L ek"P SsM3 Cdr r-- LtC Phone No. �by�-g/b-6gay Address of Firm aP- P4*V A�� E.Z GTU ;jP*- er Zip Code 066 14 Location of proposed work ttk Describe fully nature of permit requested zPt Ate CG 'f► f ? ft">> Starting date 7 9�1 g Approx.time for completion 2 " 1i ad� Call Before You Dig No. a 13a 1oa 'yl. Existing.Water Supply: � ubliie taster ❑Well Existing Sewage Service: 1ublic'Sewer [I Septic PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB LENGTH;TRAFFIC.CONTROL AND THE TOW 'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR. Show sketch of proposed work or furnish This section to be filled out by two copies of separate drawing Indicate.North Towq of South Windsor No.cuts" t yl Est.Patch Sizes) f sf ` ► Est Pvt.Thickness" in. Est.Patch Unit Price$ /sf Est.Patch Cost$ Est.Curb Replacement ft Est.Curb Unit Price S. /ft Est.Curb Cost$ Est,Traffic Unit Cost$ /hr Est.Traffic Control i Amt.of Deposit:$ � Total Due$ off. O Cash O Check# 3d QR Applicant is responsible for contacting Paid By Dsrt/2-S m of l the Police Dept.and C.B.Y.D. I OBA bkeaft Cens�racfien 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 PERMIT OUTLf TH T WN OF SOUTH WINDSOITS STREET CUT PERMI MANUAL. Signed: Date: Title: Driver's License PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OF PERMIT WORK MAY NOT BEGIN UNTIL PERMIT HAS BEEN ISSUED PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Street Excavation Permit 08 REV 10-22-08.