HomeMy WebLinkAboutStreet Cut Permits 56 Berle Road (4) 1400173
TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 06/16/2014
GIS ID: 10200056
FEE:
MUNIS APPLICATION# 201400769 � 9% EXPIRATION DATE: 25.00
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06/16/2015
APPLICANT LOCATION
NAME: ADVANCED CONS;T CTI_0N
ADDRESS: 5 CHESTNUT HILL amp /� ADDRE6EI E ROAD
j% D -I RZ 1 ICHELLE A
STAFFORD SPRIN( S, T47 i
�'� ALISA DRIVE
DLB IE DRIVE
PHONE 860-519-8442 1 fx
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WORK DESCRIPTION: �
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APPLICANT AGREES TO FURNISH THI¢ O_ Q SOi TL -013 F AND REQUIRED AND TO REIMBURSE
7M
THE TOWN OF SOUTH WINDSOR FOR AY�pEI, �S,I1 �� OIIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND T Aft-ticj .I- I�_� L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO WN�1c S( llurftIT MANUAL.
ISSUED DY �3 DAT P -RPr TED INSPECTED BY
6/1 6/2014 1 1:49AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: i yo-0 111-3 CONTRACTOR:6cloomp l Con'sy
LOCATION: ;(o 3�f��e �Qezr
TYPE OF WORK: o�lsn11� (�_ T�l
DATE INSP NEEDED: DATE INSP: I!f2//5'
INSPECTED BY: 8-0
WORK IN
PROGRESS: s--)
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: �' DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appl• No, TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
j FEE $25.00
Name of Firm '�Gy� f- 1 r Phone Na cQCj a
Address of Firm s Zip Code
Location of proposed work
Describe fully nature of permit requested
Starting date Approx. time for completion
Call Before You Dig No. !2 mG( ® 3 76 S Existing Water Supply: ❑ Public Water
❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish
two copies of separate drawing This section to be filled out by
Indicate North Town of South Windsor
No. cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
0
Est. Patch Unit Price$ /sf
Est.Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$
Est.Traffic Control$
Amt.of Deposit$
Total Due$ ��
( )Cash OCheck#
Applicant is responsible for contacting Paid B
the Police Dept.and C.B.Y.D. y
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 PERMITAND 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 //�llti'v 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