HomeMy WebLinkAboutStreet Cut Permits 95 Horizon Circle (2) 1400177
PERMIT NUMBER TOWN OF SOUTH W I N D S O R
, CT
%.,DATE: 06i16i2014 ,,, STREET CUT PERMIT
GIS ID:45000095
MUNIS APPLICATION# 201400773
FEE:
IMPIRATION DATE: 25.00
APPLICANT 0611612015
NAME: ADVANCED CONSTICTI�N _ADDRESS: 5 CHESTNUT HILL> 4D � LOCATION
w- �DDR �" pIZON CIRCLE STAFFORD SPRINGS �63 = '��� � IANCRDI MAR A
&FRANK R
PHONE 860-519-8442 ; % �� VON CIRCLE
191
_ � %
iUIIVINDSOR, CT 06074
im
WORK DESC RIPTION: IN l
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INS TAU
10i
APPLICANT AGREES TO FURNISH THE
THE TOWN OF SOUTH WINDSOR FOR �pNSOUH
CONNECTION WITH THIS PERMIT AND T" S &Il U �� _ ND REQUIRED AND TO REIMBURSE
FOR PERMITS AS OUTLINED IN THE TOWN R T� O AINTENANCE OR REPAIR WORK IN
L ABIDE BY THE RULES AND REGULATIONS
�T�UTI'EIITMANUAL.
ISSUED BY
D I
N
6/I6/2014 2:47 PM TED IlVSPEC ED BY*** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 140 017 7 CONTRACTOR: 4d Va rn U Cons'M
LOCATION: IS 4Da—i nvo P er 1e
TYPE OF WORK: 1 A sj w\\ I CU la�_C A T V
DATE INSP NEEDED: DATE INSP: i/6,/�
INSPECTED BY: 9D
WORK IN
PROGRESS:_ N C 4 T y
0
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
PUBLIC WORKS DEPARTMENT Permit No.
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm '�GPI ' r S Phone No ��
Address of Firm fi Cc t n r,� h �� (� ( I r >?��,1c�S 1�r�ti� �'
Location of proposed work -�—raT Zip Code
Describe fully nature of permit requested 1 ^ e i (i
Starting date
� Approx. time for completion
Call Before You Dig No. ,
Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS Aseptic
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish
two copies of separate drawing This section to be filled out by
Indicate North Tawn of South Windsor
No. cuts
0
Est. Patch Size(s) st
Est. Pvt.Thickness in.
Est. Patch Unit Price$____/sf
Est. Patch Cost
Est. Curb Replacement
-- _..__.._ft
Est. Curb Unit Price$__eft
Est.Curb Cost$
Est.Traffic Unit Cost$
Est.Traffic Control
Amt.of Deposit$
Total Due$
Applicant is responsible for contacting ( )Cash ( )Check#
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: ( � �I�V
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