HomeMy WebLinkAboutStreet Cut Permits 914 Ellington Road (2) 1200197 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 10/11/12
GIS ID:30300914 = FEE: .00
MUNIS APPLICATION# 201201340 EXPIRATION DATE:
APPLICANT = �„ LOCATION
NAME: METROPOLITAN DID RICT DRES 914'EL>-,INGTON ROAD
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ADDRESS: 125 MAXIM ROAD = ER t M-CPHASON MAXWELL&
HARTFORD, CT 061 f4 = 914 fl I NGTON ROAD
I 0—ow - JT INDSOR,CT 06074
PHONE
WORK DESCRIPTION: REPAk HY RANTS
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APPLICANT AGREES TO FURNISH THE W I�F,SOUT 1 TIE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANC EPENSI:S�NCUEDBTHE T�1NOR 1IAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH QI PL CANT 1S FA LIAR WITifA Q-W*L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OFbi1fiFl WII�TDS�' TR T CUT PERMIT MANUAL.
ISSUED BY DAM =SP TED INSPECTED BY
10/11/201211:08AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 0197 CONTRACTOR:
LOCATION:
TYPE OF WORK: A"IQ
DATE INSP.NEEDED: DATE INSP: 10 -9 1
INSPECTED BY: A
WORK IN
PROGRESS:_ led
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: e_W\ DATE:
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
naD-039;Rev 2112 THE METROPOLITAN DISTRICT- PAVEMENT CUT DATE;/o 7V e
ADDRESS 9111 D i14 Q oqd BILL JOB ❑ YES IZ NO
_OSEST STR ET I GL
� TOW�61jJ►tVJS6R STATE HIGHWAY C1(YES ❑NO
DRAW SKETCf SHOWING LOCATION AND SIZ OF CUTS AND CUT MADE IN e
CROSS SECTION OF PAVEMEN
El STREET ❑BITUM. ❑ CONC, DPREMIX
❑SIDEWALK ❑BITUM. ❑ CONC. D FLAG "
❑CURB ❑BITUM. ❑ CONC. QSTOhfE
pDRIVEWAY ❑BITUM. ❑GONG. IN
ElGRASS LOAM &SEED NEEDED D YES
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REASON FOR CUT;RIP I z
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DEPTH OF EXCAVATION:
\ NUMBER OF CUTS:
g ' Q DATE OF FIRST CUT:
IS JOB COMPLETED: DYES ONO
Q FOREMAN: r o
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REPLACEMENT PAVEMENT CONTRACT NO.:
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CID BITUMINOUS O CONCRETE ❑ PREMIX Q
DATE COMPLETED:
ACCOUNT NUMBER; C. ..�
CALCULATIONS '
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O CUT ITEM# ITEM# ITEMS ITEM#
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PRESS HARD 3 COPIES PAVING CONTRACTOR
CONTRACTOR
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