HomeMy WebLinkAboutStreet Cut Permits 151 Pleasant Valley R 1400150
PERMIT NUMBER TOWN OF SOUTH W I N D S O R, CT
STREET CUT PUBLIC UTILITY
DATE: 06/06/2014
GIS ID: 72900151
MUNIS APPLICATION# 201400724 FEE:
0.00
EXPIRATION DATE:
APPLICA
NAME: METROPOLITAN DID RICESA
LOC_CATION
ADDRESS: 125 MAXIM ROAD = A_DDW% 1 P ASANT VALLEY ROAD
HARTFORD, CT 06 14y _ ,. pALAijINI CHRISTOPHER M
AF
&SANT VALLEY ROAD
PHONE --„ J7TIVINDSOR,CT 06074
WORK DESCRIPTION: REI`,Af
VWT4IVCr����M�'DI��i�VO,$1$2=
APPLICANT AGREES TO FURNISH THB''OI'4 1 O SpUNDR� pI-0T ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A1III' :PENSES II�eRE
CONNECTION WITH THIS PERMIT AND TH_ - PLI ANT IS __ ,,"T IAR LL ABIDE NA THE RULES ANDWORK
IN
FOR PERMITS AS OUTLINED IN THE TOWN CIF SOUTH WIN3SRYS 5T
-- T"CITY PERMIT MANUAL. REGULATIONS
ISSUED BY DATE INSPECTED
INSPECTED BY
6/6/2014 2:02 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
T - ;
i _
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 00 S® CONTRACTOR: M
LOCATION: P lem Saal"' i/AI Ie st 90a 1
TYPE OF WORK:�p�It C4� a InaDATE INSP INSP NEEDED: DATE INSP: 19,Lf hy
INSPECTED BY: 3
WORK IN
PROGRESS: / C /ZwlaceA i 56 ° . em
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/2014 Town of South Windsor INPSECfION 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 $25.00
Name of Firm 4 M1FT/IOft ITAAt +Dl,IT 1C Y Phone No. 60-a?0' 7050
Address of Firm 5 M4 Al R 0 Zip Code D /r
Location of proposed work L9.1 (GATANT V-4t W{ AYJ
Describe fully nature of permit requested
R IE PGA C E)rt S 7, N T uvg S6 0 0 10�-
Starting date (J "7 Call Before You Dig No M ri Y o2 O 2 0 4
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETER WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut '"Pavement Cut Ar Curb Cut ❑ Sidewalk Out
❑ Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
0 No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price
Est.Patch Cost$ III
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 PENSE CURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND
THAT I AM MI WITH D ILL ABI E BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDSOR' S U ti 17-
Signed: Print Name 0 y+• ` y�''+tffh Date: Ij-
P
SV
Street Exca tI n ermit 2014