HomeMy WebLinkAboutStreet Cut Permits 19 Simcka Drive (3) 1300305 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 12/05/2013
GIS ID: 82800019 = ,= FEE: 25.00
MUNIS APPLICATION# 201301788 EXPIRATION DATE: 12/05/2014
APPLICANT LOCATION
NAME: LAYDON INDUSTRIS.LLG
ADDRESS' INtICKA DRIVE
ADDRESS: 51 LONGHINI LANK R BUIZCISON CHARLES O SR&JENNIFER O
NEW HAVEN, CT 0651� - I9MCKA DRIVE
OUTI1 VINDSOR, CT 06074
PHONE
WORK DESCRIPTION: PAVEMEI�IT RE3I ORATION FOR MDC ;
APPLICANT AGREES TO FURNISH THEE OV ]OF SOUTH INDS-OR PHE AMOUNT O BUND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EKPENSES INCURRED BY THE;TOWN FOP F AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND ThE APPLICANT IS FAMILIAR WITH AND- _WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSR S STREET GUT PERMIT MANUAL.
ISSUED BY DATE INS ECTED INSPECTED Y
12/5/2013 1:54 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: Lo-yc4or` i vs
LOCATION:
TYPE OF WORK: yaV c y"V ot
DATE INSP NEEDED: DATE INSP: /a
INSPECTED BY: B D
WORK IN
PROGRESS: 'a 3 /D . �C 3 C L 1
Yv e r yvi a, PCA�,n L&s-c S en�( Qa u--c
C®
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES [:] NO
AS-BUILT:
INPUT: DATE:
S/2014 Town of South Windsor INPSEMON REPORT 14
tot 3017 :Z APPLICATION FOR STREET EXCAVATION PERMIT `3ocl-3r_>-�
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT 1540 SULLIVAN AVENUE Date: rQ LsL6
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm ��-e t (1 �r('17'-
� �e-1 Phone No.
Address of Firm �� �„C�f1C�f`� Lnun n Zip Code Ck- ic?�
Location of proposed work
Describe fully nature of permit requested
•rye S'tcx -4
Starting dab Approx. time for completion `t
Call Before You Dig No. :e �-1�lC� i � Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
Est. Pvt. Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$ Jft
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.
---- -1 AGREE TO FURNIS -T fs,TOWN-OF-SOUTH WINDSOR-THE AMOUNT-OF-BOND-REQUIRED AND-TO REIMBURSE-THE--
TOWN OF SOUTH W SOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTI. H IS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS'ASO T D 1 THE 7T(�VN OF SOUTH WIND.SOR'S STREET CUT PERMIT 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 A PERMIT HAS BEEN ISSUED
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
StraPt Exravahnn PPrmif 08 RFV 1 n-72-09
0.039,Rev 2112
r� THE METROPOLITAN DISTRICT- PAVEMENT CUT DATE: S-I S--1
ADDRESS I°7 q'7 b7 BILL JOB ❑YES XNO WO# ,-,.r 47
CLOSEST STREET V C� �j, TOWN �, btJ�By�f p� STATE HIGHWAY DYES O
ORA SKETCH SHOWING LOCATION AND SIZE OF UTS AND
CROSS S TION OF PAVEMENT CUT MADE IN
1 JBSTREET XBITUM. " ❑CONC. ❑PREMIX
] ❑SIDEWALK ❑BITUM. ❑CONC. ❑FLAG
❑CURB ❑BITUM. ' ❑CONC. ❑STONE
Q DRIVEWAY ❑BITUM. " Q CONC. "
❑GRASS LOAM&SEED NEEDED ❑YES NO
REASON FOR CUT.__. z
dam, �� ,� . l�• `o
6, I
0
DEPTH OF EXCAVATION:
NUMBER OF CUTS:
z
DATE OF FIRST CUT:
IS JOB COMPLETED: RYES ONO
FOREMAN:
1201 W Gut2t3 `
0 Ot REPLACEMENT PAVEMENT CONTRACT NO.:
BITUMINOUS ❑ CONCRETE❑ PREMIX Q
DATE COMPLETED:
ACCOUNT NUMBER: a�//o
CAtiLCULATIONS
NO N
OF CUT ITEM# ITEM# ITEM# ITEM#
`�
PRESS HARD, 3 COPIES PAVING INSPECTOR CONTRACTOR
(ORIGINAL) {YELLOW)