HomeMy WebLinkAboutStreet Cut Permits 9999 Stanley Drive (2) 1400240 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 08/14/2014
GIS ID: 85209999 - FEE:
MUNIS APPLICATION# 201401114 = 25.00
EXPIRATION DATE: 08/14/2015
APPLICANT LOCATION
NAME: MARTIN LAVIERO CONTRACTORS ` ADDRESS: : 9�9 STANLEY DR S/E CORNER OF SALLY
ADDRESS: 611 NORTH MAIN SRIffT OWNER TOWNF SOUTH WINDSOR
P O BOX 1659 - 1540 SULLIVAN AV
BRISTOL,CT 06010--429 S OR,CT 06074-2734
PHONE 860-589-7579 = = =-
WORK DESCRIPTION: REPAIR BLACK IOP FOR MDC
APPLICANT AGREES TO FURNISH THE NOVVN OF SOUTH WINbSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY L PEN ES,INCURRED BYTHE TOWNFOR44AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TIDE A'PLICANT IS FAMILIAR WITH ANT)WALL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OI SOUTH WINDSOR'S STREET CUTPERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
8/14/2014 9:15 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:.. �00 A g0 CONTRACTOR:_ffla(j m Cc V 64o Goa lr1k or s
LOCATION: _ 1t: cD2 her D
TYPE OF WORK:—AWa i L? Q cn ►�') ��L°�
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 8
WORK IN
PROGRESS: � �
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: CIT-- DATE: 1 aT_
S/2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074 FEE $25.00
Name of Firm Martin Laviero Contractor, Inc. Phone No.860-589-7579
Address of Firm 611 North Main Street, Bristol, CT Zip Code 06010
Location of proposed work Stanley Drive (a S/E Corner Sally Drive, South Windsor CT
Describe-fully nature of permit requested ID� p d I S-fPd2K.d bLI N b C CrZ(A) ,
Starting date8/11/2014 Call Before You Dig No20143202505 � U
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
.Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
17
�+ C No.cuts
�l1 U ip i e-S 0 Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est. Sidewalk Replacement sf
Est.Sidewalk Unit Price$ /sf
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( ( )
Applicant is responsible for contacting the Police Dept.and C.B.Y.D )Cash Check#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Paid By
(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: Print Name Date:
Street Excavation Permit;2014
MD-039,Rev 2/12 THE METROPOLITAN DISTRICT - PAVEMENT CUT DATE:
BILL JOB 17� YES ),C NO WO#
ADDRESS mijt- cog �'Ak
CLOSEST STREET—
TOWN I tu"0.50 STATE HIGHWAY DYES NO
DRAW SKETCH S iO'q NG LOCATION AND SIZE OF C TS AND CUT MADE IN
CF OS 5.SECTION OF PAVEMENT
- STREET )ZBiTUk '0 - El CONC. '— 0 PREMIX
El SIDEWALK DBITUM. - El CONC.-- 0 FLAG
kCURB C 31TUM. 0 CONC. 0 STONE
0 DRIVEWAY D B[TUM. F-1 CONC. 7
PGRASS LOAM&SEED NEEDED 0 YES aNO
m
0
F,
REASON FOR CUT. k CR j z
o
DEPTH OF EXCAVATION:
K
c NUMBER OF CUTS:
z
<
DATE OF FIRST CUT.
IS JOB COMPLITED: AYES ONO
FOREMKN--��' 6, L A-dl—"C S,
REPLACEMENT PAVEMENT CONTRACT NO.:
BITUMINOUS El CONCRETE 0 PREMIX El
DATE COMPLETED:
ACCOUNT NUMBER:
CALCULATIONS
NO.
OF CUT ITEM# ITEM# ITEM# ITEM#
PAVING INSPECTOR CONTRACTOR
PR HARD, 3 COPIES (ORIGINAL) (YELLOW) redd 7/18/2014
A ?,[ io
MD-039,Rev 2/12 THE METROPOLITAN DISTRICT - PAVEMENT CUT DATE:
ADDRESS -53 ii,-4 tj 1 4,06,1 SAL4 -q Qtq BILL JOB El YES ,,C NO wo#-S-�" F/
TOWN J., NO
CLOSEST STREET (A)J fU 4-10 STATE HIGHWAY El YES
DRAW SKETCH S iOlIV NG LOCATION AND SIZE OF CUTS AND CUT MADE IN
CFO$3 SECTION OF PAVEMENTC�S TREET Wj3ITUM. 4f - El CONC. 0 PREMIX
0 SIDEWALK D BITUM.-" El CONC. 0 FLAG
0
O-CURB E4,BITUM. DCONC. 0 STONE
0 DRIVEWAY El BITUM. El CONC.
0
qQGRASS LOAM&SEED NEEDED 0 YES [2-NO
REASON FOR CUT- zo .
DEPTH OF EXCAVATION:
NUMBER OF CUTS:
1
DATE OF FIRST CUT. z
5
IS JOB COMPL ED: AYES ONO
ey k-'-C 5,
FOREM IL C- N
REPLAC6AENT PAVEMENT CONTRACT NO.:
BITUMINOUS El CONCRETE 0 PREMIX El
DATE COMPLETED:
ACCOUNT NUMBER,
CALCULATIONS
NO.
OF CUT ITEM# ITEM# ITEM# ITEM#
PAVING INSPECTOR CONTRACTOR
PR� HARD, 3 COPIES (ORIGINAL) (YELLOW) redd 7/18/2014