HomeMy WebLinkAboutStreet Cut Permits 74 Edgewood Drive (2) 1400244 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/14/2014 ;
GIS ID:29400074 FEE: 25.00
MUNIS APPLICATION# 201401118 EXPIRATION DATE: 08/14/2015
APPLICANT LOCATION
NAME: MARTIN LAVIERO NTRACTORS ' ADDRESS: 7� DIUWOOD DRIVE
ADDRESS: 611 NORTH MAIN SRET OWNER PHILIPIRGINIA M
P O BOX 1659 74 EDGWOOD DRIVE
BRISTOL,CT 0601044; SOUTH VINDSOR.CT 06074
PHONE 860-589-7579 = "
WORK DESCRIPTION: REP%- 1 B iACKTOP FOR MDC- "
APPLICANT AGREES TO FURNISH TllftOV --OF SOUTH-W NDSOR THE AMOLtI T OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYPENSES INCCTRREDBY-THE TOWN=FORIvIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TI1L.APPLICANT IS FAMILIAR WI--T'H ANC W_j�L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN f)F SOVi-H WINDSOR'&STREET CUTPERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECT PI) BY
8/14/2014 9:55 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: j y 00� CONTRACTOR: f Y� �i U P2 con�('. '��',S
LOCATION: '7 y unnne
TYPE OF WORK: iyv m t)r-
DATE INSP NEEDED: DATE INSP: 2
INSPECTED BY:' p
WORK IN
PROGRESS:_}
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/2014 Town of South Windsor INPSECTION 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 $25.00
Name of Firm Martin Laviero Contractor, Inc. Phone No.860-589-7579
Address of Firm 611 North Main Street, Bristol CT Zip Code 06010
Location of proposed work74 EdgeWood Drive, South Windsor, CT
Describe fully nature of permit requested C J .IDIL I✓ f3�g(�,t;J`y,� QC if rz1��( h� �,�>�
Starting date8/11/2014 Call Before You Dig No20143202507
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer Cl Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
Est. Patch Size(s) sf
Est, Pvt.Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est. Sidewalk Replacement sf
Est.Sidewalk Unit Price
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ 1hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting the Police Dept.and C.B.Y.D
PERMIT SHALL BE KEPT ON JOBSITE AT ALL'LIMES Paid By
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: Print Name Date:
Street Excavation Permit 2014
MD-039,Rev 2112 THE METROPOLITAN DISTRICT - PAVEMENT CUT DATE: r _
f` ADDRESS -7 q g BILL JOB ❑ YES �O WO# S lJ� -
E CLOSEST STREET d 2, ,6f" 1 TOWN W f rNdj 0& STATE HIGHWAY Cl YES 9JO
DRAW SKETCH SHOWING LOCATION AND SIZE OF CUTS AND
CUT MADE IN
GROSS SECTION OF PAVEMEN
P,8fREET ❑BITUM. " ❑CONC. ❑PREMIX
❑SIDEWALK ❑BITUM. ❑CONC. ❑FLAG
511
URB ITUM. ', [I CONC. ❑STONE
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RASS LOAM &SEED NEEDED ❑YES 9-NO z
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REASON FOR CUT: o
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LA DEPTH OF EXCAVATION: �j•of o
NUMBER OF CUTS: Z
' DATE OF FIRST CUT-.—
IS JOB COMPLETED: ES ONO
FOREMAN: 4
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REPLACEMENT PAVEMENT CONTRACT NO.:
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BITUMINOUS ❑ CONCRETE ❑ PREMIX ❑
DATE COMPLETED:
CV r I ,
� ACCOUNT NUMBER:
`t- �_ CALCULATI NS
f NO.
OF CUT ITEM# ITEM# IT M# ITEM#
I
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PRESS HARD 3 COPIES P'4V1�ORINSPECTOR CONTRACTOR
( reed 7/18/2014 40
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ADDRESS BILL JOB ❑ YES O WO#
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F CLOSEST STREET �! Z' ' 4 4 ` 7' TOWN STATE HIGHWAY ❑YES 0 10
DRAW SKETCH SHOWING LOCATION AND SIZ OF CUTS AND
CUT MADE 1N
CROSS SECTION OF PAVEMEN -IN
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❑CONC.
P�lTREET ❑BITUM. " El PREMIX
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RASS LOAM &SEED NEEDED ❑YES , 2 d i
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REASON FOR GUT: I Pal,gc F `° Grs 164�VFW z
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NUMBER OF CUTS: {
IV DATE OF FIRST CUT: f o
IS JOB COMPLETED: eolES ❑NO
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FOREMAN: —�
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REPLACEMENT PAVEMENT CONTRACT NO.:
� I BITUMINOUS ❑ CONCRETE ❑ PREMIX ❑
BATE COMPLETED:
v r � + ACCOUNT NUMBER: ) `
l CALCULATI NS _
NO.
OF CUT ITEM# ITEM# IT M# 1TEM# m
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PRESS HARD 3 COPIES PAVING INSPECTOR CONTRACTOR
( reC'd 7/18/2014
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