HomeMy WebLinkAboutStreet Cut Permits 11 Hearthstone Drive (3) 1400296 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/30/2014
GIS ID:41100011 FEE: 25.00
MUNIS APPLICATION# 201401388 R-PIRATION DATE: 09/30/2015
APPLICANT LOCATION
NAME: ADVANCED CONSTRI7CTION ADDRESS: ` 1 1 TEATHSTONE DRIVE
ADDRESS: 5 CHESTNUT HILL ROAa OWNER:" GRSTN CEIL SARETTA
STAFFORD SPRING, CT06076 11 ITEARTHSTONE DR
SOUTH W INDSOR,CT 06074
PHONE 860-519-8442
WORK DESCRIPTION: INSTALI,REPLACE CATV
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WINDSQR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURREDBY THE TOWN FOR 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 WINDSOR'S STREET CUT ISE*T MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
9/30/2014 11:24 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: IYOO, CONTRACTOR: hc1 mf206e?d 00i257W
LOCATION:_
a
TYPE OF WORK: I o S td 11 r P a J ILC'o CA T V
DATE INSP NEEDED: DATE INSP: i i 3 iS
INSPECTED BY: 6p
WORK IN
PROGRESS: IJC6d (-./f_r v i�ej91 AC.e
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
I
INPUT: L DATE:
S/molloy/forms 2014 Town of South Windsor INPSECfION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm 'a Gy� ' e
4iLfAddress of Firm S Phone No. 5 r�
�+� �' P o!"ci�S r0.cr 1C - Zip Code
Location of proposed work � � �� ., � � �if
Describe fully nature of permit requested ` ` �� I I /�P ►n r o
Starting date
Call Before You DI No. Approx. time for completion / �
9 I��� '� ; S-o Existing Water Supply: ❑ Public Water
❑Well
Existing Sewage Service: ❑ Public Sewer El septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS, THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish
two copies of separate drawing This section to be filled out by
Indicate North Town of South Windsor
No. cuts
0
Est. Patch Size(s) . sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$________/sf
Est. Patch Cost$
Est. Curb Replacement fi
Est. Curb Unit Price$
Est. Curb Cost$
Est.Traffic Unit Cost$
iEst.Traffic Control$ f
Amt.of Deposit$
Total Due
Applicant is responsible for contacting ( )Cash O Gheck#
the Police Dept.and C.B.Y.D. 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 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:_ (� ��lhV
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