HomeMy WebLinkAboutStreet Cut Permits 9999 Gail Lane (3) 1400241 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE:'08/14/2014 = "
GIS ID: 34509999 .." FEE: 25.00
MUNIS APPLICATION# 201401115 - IIXPIRATION DATE: 08/14/2015
APPLICANT LOCATION
NAME: MARTIN LAVIERO G�NTRACTOR , ADDRESI� GtI 1sANE @CHAPEL RD
ADDRESS: 611 NORTH MAIN S�RLT t3WNE ;"- TOWN bF SOUTH WINDSOR
P O BOX 1659 0 1 4t-SU1 LIVAN AVE
BRISTOL,CT 06010�4029, - S tVI D OR, CT 060742734
PHONE 860-589-7579 = -
WORK DESCRIPTION: RE PAL BLtCI TOP FOF£MDC
Al
APPLICANT AGREES TO FURNISH THETOM-q OF SOUTH WINDSOR NT THE AMOU OF BbND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AT* EXPENSES INCTJRRED$Y THE TOWN FOR GIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT IS FAMIL I- WLTLI AI�1 WJ L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN 6F SOUTH WINDSOR'S STREET CUT PI✓R1vIIT MANUAL.
c 1
ISSUED BY DATE INSPECTED INSPECTED BY
8/14/2014 9:25 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I y 00,9 y I CONTRACTOR: Ma ef; A) Lay I eg-p O r)-TrA
LOCATION: -rr3���
TYPE OF WORK: k 4n,a Alv C_
DATE INSP NEEDED: DATE INSP: to
J�q
INSPECTED BY: 6k,
WORK IN
PROGRESS: 9 X 6, /vta_c�_Q '�o; e: 1w LS—L±
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES [:] NO
AS-BUILT:
INPUT: DATE: v-k
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 $25.00
Name of Firm Martin Laviero Contractor, Inc. Phone No.860-589-7579
Address of Firm 611 North Main Street, Bristol, CT Zip Code 06010
Location of proposed work Gail Lane Chapel Road South Windsor !rhyeb
Describe fully nature of permit requested "- ,e.y
Starting date8/11/2014 Cali Before You Dig No 20143202512
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
r
No.cuts
0 Est. Patch Sizes) sf
4� Est. Pvt.Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
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$
O Cash O Check#
Applicant is responsible for contacting the Police Dept.and C.B.Y.D
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES 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 2/12 THE METROPOLITAN DISTRICT e PAVEMENT �T DATE:
ADDRESS �z�r t'" % F .G" BILL JOB El YES G WO#
CLOSEST STREET _ TOWN �- � � �f ��y ' STATE HIGHWAY ❑YES CT90
zl-
DRAW SKETCH SHOWING LOCATION AND SIZE OF CUTS AND / CUT MADE IN
CROSS SECTION OF PAVEMENT /S f
L[5 BEET € rTUM. ❑CONC. ❑PREMIX
❑SIDEWALK ❑BITUM. ❑CONC. ❑FLAG
[5;�-6F�B asiffUM. `7 ' ❑CONC. ❑STONE
❑DRIVEWAY ❑BITUM. ❑ CONC. "
�aql6rASS LOAM&SEED NEEDED ❑YES
CRr - REASON FOR CUT:
DEPTH OF EXCAVATION: ' �.
NUMBER OF CUTS: z
DATE OF FIRST CUT:
IS JOB COMPLETED: ETY'ES ONO
FOREMAN: 1':*� �
REPLACEMENT PAVEMENT CONTRACT NO.:
BITUMINOUS ❑ CONCRETE ❑ PREMIX ❑
DATE COMPLETED:
ACCOUNT NUMBER:. .
CALCULATIONS
NO. N
A
OF CUT ITEM# ITEM# ITEM# ITEM#
i
PAVING INSPECTOR? CONTRACTOR �
PRESS HARD, 3 COPIES (ORIGINAL) (YELLOW) reC d 7/18/2014 �
MD-039,Rev 2/12 THE METROPOLITAN DISTRICT- PAVEMENT CUT DATE: G •7 -'x`
ADDRESS 'fa`'l` 6s'j �'� BILL JOB ❑ YES WO#
CLOSEST STREET , r� TOWN ' �>�' STATE HIGHWAY El YES CTNO
I
DRAW SKETCH SHOWING LOCATION AND SIZE OF CUTS AND • CUT MADE IN
CROSS SECTION OF PAVEMENT 1-5- _
l� REET ( TUM. ❑ CONC. ❑PREMIX "
❑SIDEWALK ❑BITUM. ❑ CONC. ❑FLAG
�FfB ®"BITUM. `ter ' ❑CONC. ❑STONE
\ ❑DRIVEWAY ❑BITUM. " ❑CONC. "
RASS LOAM&SEED NEEDED ❑YESrn
CPde'
`0
REASON FOR CUT: z
C} � Ux o
v,
DEPTH OF EXCAVATION: a _ .
NUMBER OF CUTS; �
DATE OF FIRST CUT: o
IS JOB COMPLETED: CCU ES ONO m
o
FOREMAN: t'
REPLACEMENT PAVEMENT CONTRACT NO.:
BITUMINOUS ❑ CONCRETE ❑ PREMIX ❑
DATE COMPLETED:
ACCOUNT NUMBER: .- �.. '�
CALCULATIONS
NO.
A
OF CUT ITEM# ITEM# ITEM# ITEM#
,I
�I.
I
PAVING INSPECTOR CONTRACTOR
PRESS HARD, 3 COPIES ORGIAL (YELLOW) reC'd 7/18/2014