HomeMy WebLinkAboutStreet Cut Permits 21 Country View Drive (2) 1400097 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 05/01/2014
GIS ID:24300021
MUNIS APPLICATION# 201400483 FEE: 25.00
EXPIRATION DATE: 05/01/2015
APPLICANT LOCATION
NAME: ADVANCED CONS LtUcTION ADDRESS; 2f,COVNTRY VIEW DRIVE
ADDRESS: 5 CHESTNUT HILLR(ff - OWNER BORR JUDITH A
STAFFORD SPRINS��T 06076 COUNTRY VIEW DRIVE
PHONE 860-519-8442 = Sou Windsor,CT 06074
WORK DESCRIPTION: INS`1 ALp,REPLACE CATV /
APPLICANT AGREES TO FURNISH THE T01 OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY�EXPENSES INCURRED'BY THE TOWN FOI'MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDS 'S STREET`CUTPI RMIT MANUAL.
IleI /
ISSUED BY DATE INSPECTED
INSPECTED BY
5/l/2014 11:04 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 006 -7 CONTRACTOR:
LOCATION:_ 0- , Cnu n ru Viet.) �,q; _e
TYPE OF WORK:_ m C+a 11 r:A--rl/
DATE INSP NEEDED: DATE INSP: //V/f.-
INSPECTED BY:
WORK IN
PROGRESS: a
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: �- � DATE:
S/2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm r Phone No.
Address of Firm h;X� (�
Location of proposed work
Describe fully nature of permit requested 1 L ,
Starting date_ /2 Call Before You Dig No. Approx• time for completion / v
,,� Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish
two copies of separate drawing This section to be filled out bar
Indicate North Town of South Windsor
No. cuts
0
—�_ Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
t --_ Est. Curb Replacement----__--_ ---v n
Est. Curb Unit Price$ /{t
Est. Curb Cost$—.
6u�� Est.Traffic Unit Cost$
Est.Traffic Control$ +
Amt.of Deposit$
Total Due
( )Cash ( )Check#
Applicant is responsible for contacting Paid By__
the Police Dept.and C.B.Y.D.
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: P_ %/�l�ti��1
Date:-
Title: Driver's License#:
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OF PERMIT
WORK MAY NOT BEGIN UNTIL A PERMIT HAS BEEN ISSUED
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08 REV 10-22-08