HomeMy WebLinkAboutStreet Cut Permits 335 Clark Street (2) 1400243 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/14/2014
GIS ID:20400335 FEE: 25.00
MUNIS APPLICATION# 201401117 EXPIRATION DATE: 08/14/2015
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APPLICANT LOCATION
NAME: MARTIN LAVIERO W_.NTRACTORS ADDRESI; 33 -CUARK STREET
ADDRESS: 611 NORTH MAIN STREET OWNER WAYNE:ADAM D&STACEY B
P O BOX 1659 = _ 335'CL ARK ST
BRISTOL,CT 0601024jU-9 OUTLj VINDSOR,CT 06074
PHONE 860-589-7579 -
WORK DESCRIPTION: RERM-'"BACK OP F{}R MDC>
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APPLICANT AGREES TO FURNISH THEVOM_q OF SOUTH[ INDSOR THE AMOUNT OF BAND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANXPBNSES INCURRED BY THE TOWI�IFOKAVIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TIC APPLICANT IS FAMILIAR WITH AID WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O�SOUTH WINDSOR'S-STREET CUTP RIvIIT MANUAL.
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ISSUED BY DAT IN '` " CTED INSPECTED BY
8/14/2014 9:50 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /t- W a y3 CONTRACTOR: n Later e(,o CenItAckk
LOCATION S--,5r C Iat y :k—fee`
TYPE OF WORK: 'CiP"r 6\U c_L tw2 '�r
DATE INSP NEEDED: DATE INSP: z-04.Z,11z
INSPECTED BY:' Q
WORK IN
PROGRESS: ALA
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
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 $25.00
Name of Firm Martin Laviero Contractor, Inc. Phone No.860-589-7579
Address of Firm 611 North Main Street, Bristol CT Zip Code 06010
Location of proposed work 335 Clark Street, South Windsor, CT
Describe fully nature of permit requested _ C A /may/
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Starting date 8/11/2014 Call Before You Dig No 20143202515
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk G u ppt
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
Est. Patch Size(s) sf
4�4 Est.Pvt.Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price
Est.Curb Cost$
Est. Sidewalk Replacement sf
Est.Sidewalk Unit Price
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
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 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-oss,Rev 2/12 THE METROPOLITAN DISTRICT - PAVEMENT CUT DATE:'
ADDRESS S ['.l �~ -�%'� BILL JOB ❑ YES ❑ NO WO# S'�935b
t` I
CLOSEST STREE TOWN .f.)&o0-ICO r STATE HIGHWAY ❑YES 'RNO
DRAW SKETCH SHOWING OCATION AND SIZE OF CUTS AND CUT MADE IN
CROSS SE TION OF PAVEMENT.
. �� ,STREET adiTUM. _" ❑ CONC. ❑PREMIX
❑SIDEWALK ❑BITUM. ❑ CONC. ❑FLAG A
❑CURB ❑BITUM. ❑CONC. ❑STONE
❑DRIVEWAY ❑BITUM. ❑ CONC.
lRASS LOAM &SEED NEEDED. ❑YES P°NO _
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REASON FOR CUT:
0
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DEPTH OF EXCAVATION: (a�. o o
NUMBER OF CUTS: z
o DATE OF FIRST CUT: G
� IS JOB COMPLETED: S ONO b
FOREMAN: lig-'r o lz
ell
7 REPLACEMENT PAVEMENT CONTRACT NO.:
BITUMINOUS ❑ CONCRETE ❑ PREMIX ❑
DATE COMPLETED:
ACCOUNT NUMBER: Cz
CALCULATIONS
NO.
F CUT ITEM# ITEM# ITEM# ITEM#
PAVING INSPECTOR CONTRACTOR
PRESS HARD, 3 COPIES (ORIGINAL) (YELLOIN) red d 7/18/201: ;
y.;.
o
MD-039,Rev2112 THE METROPOLITAN DISTRICT - PAVEMENT CUT DATE:.
ADDRESS BILL JOB El YES ❑ NO WO# S�'�39
CLOSEST STREET Zrh> �_ TOWN ,J'. 62i,206-0 r STATE HIGHWAY ❑YES YHNO
DRAW SKETCH SHOWING OCATION AND SIZE OF CUTS AND �CUUTT MADE IN
CROSS SE TION OF PAVEMENT 33S ! 'STREET P, ITUM._-y-" ❑ CONC. ❑PREMIX
❑SIDEWALK ❑BITUM. " ❑ CONC. ❑FLAG
❑CURB ❑BITUM. ' ❑ CONC. ❑STONE
❑DRIVEWAY ❑BITUM. ❑ CONC. "
96RASS LOAM &SEED NEEDED. ❑YES ,ENO
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REASON FOR CUT: , t✓CTr/,T,� z
0
0
Lo
DEPTH OF EXCAVATION: �. ® � o
NUMBER OF CUTS:
t• ' DATE OF FIRST CUT:
�? IS JOB COMPLETED: 4�04 S ONO
FOREMAN:
I -wt
-- . REPLACEMENT PAVEMENT CONTRACT NO.:
BITUMINOUS ❑ CONCRETE ❑ PREMIX ❑
DATE COMPLETED.
ACCOUNT NUMBER: cz P
CALCULATIONS
NO. N
OF CUT ITEM# ITEM# ITEM# ITEM#
I
I
PAVING INSPECTOR CONTRACTOR
PRESS HARD, 3 COPIES (ORIGINAL) (YELLOW) reC d 7/18/201:: ..; : . !'