HomeMy WebLinkAboutStreet Cut Permits 107 Ridgefield Drive (2) 1400175 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/16/2014
GIS ID: 75900107At
FEE: 25.00
MUNIS APPLICATION# 201400771 ,XPIRATION DATE: 06/16/2015
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APPLICA �
i CATION
NAME: ADVANCED CON UCTI& - i DDRE ( RI GEFIELD DR
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ADDRESS: 5 CHESTNUT HILL D; � Ir-T ILTOJ JOYCE A&DAVID A
STAFFORD SPRING SS T A ! I D EFIELD DRIVE
y -a-m-m- - % -elk4TVINDSOR CT 06074
PHONE 860-519-8442SLL-
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WORK DESCRIPTION: INSAt& A� ��
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APPLICANT AGREES TO FURNISH THEE O�® OLrL 3 �THE TOWN OF SOUTH WINDSOR FOR AM9I1I�F 17ND REQUIRED AND TO REIMBURSE
A �' P SI II�fi��I H1 ��2WI ORI-AlAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE tL" I�AT IhrI XTH
-ANDWAl ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO -&TtWaff MANUAL.
ISSUED BY D fN TED INSPECTED BY
6/16/20142:12PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: yogl 7.s' CONTRACTOR: lujigoed cglx,
LOCATION: Adgegifv %yJ
TYPE OF WORK: i n.s
DATE INSP NEEDED: DATE INSP: % //Z /S-
INSPECTED BY: �
WORK IN
I PROGRESS: C'l 4.P1
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: 011', I
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
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APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
y FEE $25.00
Name of Firm '�Gy► ✓�r� �F�i"� C��r1 S n G I�n E �n I Se Phone No,� o '5 0e/z/�
Address of Firm_ h Sf` rA'f�I\:�� rp j�j �. s aY C s
� N f�ro'�'� Zip Code
Location of proposed work �'
Describe fully nature of permit requested
Starting date Approx. time for completion
Call Before You Dig No. 2 r4 ?anj q n 5 Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish T_ his section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
0
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est.Patch Cost
Est. Curb Replacement
Est. Curb Unit Price$ /ft
Est.Curb Cost$
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.
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Signed:T; �7 Dater
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