HomeMy WebLinkAboutStreet Cut Permits 1509 Ellington Road (2) 1400194 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 07/07/2014
GIS ID: 30301509 FEE: 0.00
MUNIS APPLICATION# 201400890 = - EXPIRATION DATE:
APPLICAI LOCATION
NAME: METROPOLITAN D TRIC, ADDRESS: 11,69 I ,LINGTON ROAD
ADDRESS: 125 MAXIM ROAD, 1 -- R 7iJLIEI CARMEN
HARTFORD,CT OCR 1 15ffM9&INGTON ROAD
sSPUHVINDSOR, CT 06074
PHONE
WORK DESCRIPTION: RE13I� B=I Y 7RANT t3V-0 5608187 ,
APPLICANT AGREES TO FURNISH THI TO 1 OF I- CTI V I)SOR'THI AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AEI'=I XPEI�TFYES-II ICIJRRED BIY THIT-3WI FOIvIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND Tk APPLICANT I$TAMIT IAR WITH AND W4LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOW"F SOUTH WINDSR' STREE PCUTPIIIMIT MANUAL.
ISSUED BY DATE'INSPECTED INSPECTED BY
7/7/2014 10:46 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: i CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:___l9&2/Z
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: - DATE: 01
S/2014 Town of South Windsor INPSEMON REPORT 14
MD-039,Rev 2112 THE METROPOLITAN DISTRICT- PAVEMENT CUT DATE:.=a�-/.y
ADDRESS:_ . .. .� U ! �l�.i�aT�1 _.. !'CA _ ... BILL JOB "O_YES
CLOSEST STREET 1 %��e TpWN .S. (i)i n otli f STATE HIGHWAY 51YES ❑NO
DRAW SKETCH SH WING LOCATION AND VZE OF CUTS AND 1
CUT MADE IN -
CRC S SECTION OF PAVEM ENT
❑STREET ❑BITUM.�" ❑CONC. ❑PREMIX_"
❑SIDEWALK ❑BITUM,_" ❑CONC. ❑FLAG
❑CURB ❑BITUM. ' ElCONC. ❑STONE '
XVEWAY ElBITUM. " ❑CONC.
ASS LOAM&SEED NEEDED ❑YES WO
m
REASON FOR OUT:
o -.1
a
0
DEPTH OF EXCAVATION:
NUMBER OF CUTS: j
DATE OF FIRST CUT:
IS JOB COMPLETED; *TfS ONO
FOREMAN:
/ REPLACEMENT PAVEMENT CONTRACT NO.:
P O r BITUMINOUS ❑ CONCRETE❑ PREMIX❑
a DATE COMPLETED: �7
ACCOUNT NUMBER: !'
Q CALCULATIONS
OF CUT ITEM S ITEM# ITEM ITEM#
PAVING INSPECTOR CONTRACTOR
PRESS HARD, 3 COPIES (ORIGINAL) (YELLOW)