HomeMy WebLinkAboutStreet Cut Permits 171 Old Farm Road (3) 1400092 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 05/01/2014
GIS ID: 66300171
MUNIS APPLICATION# 201400478 FEE: 25.00
EXPIRATION DATE: 05/01/2015
APPLICANT - LOCATION
NAME: ADVANCED CONSTRUCTION ADDRESS: 17I=ODD FARM ROAD
ADDRESS: 5 CHESTNUT HILL 1OAD OWN> R: KINSNN HOWARD K JR&CAROL A
STAFFORD SPRINCisTOf-76 171"bL FARM ROAD
PHONE 860-519-8442 = SOUTH WINDSOR,CT 06074
WORK DESCRIPTION: INSTAIA,kEPLACE CATV -
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WINDSOR THE AM�}U1QT OF BAND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANV I OPENS- INCURRED BY THE TdWN FOR=IvIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH1 APPLICANT IS FAMILIAR WITH AND W-ILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO WN bF SOUTH WINDSR'S STREET CUT: IT MANUAL.
ISSUED BY � ''
DATE INSPECTED INSPECTED BY
5/1/201410:45AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: o? CONTRACTOR:....
LOCATION: ( 11 old Fa2 m 5 goa A
TYPE OF WORK: i yl_s j-r, t l / ,-P,21 Q C'& CA71"
DATE INSP NEEDED: DATE INSP: ll og h-5
INSPECTED BY: (9_a
WORK IN
PROGRESS: C A v oo
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: P� "
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 $25.00
Name of Firm ,a Gy� :i r Phone No. ��/ `/
Address of Firm �X ) I `-i
Ec n r,r- '� r� �
Location of proposed work
Describe fully nature of p rmit requested
Starting date GF)'/'Z- Approx. time for completion
Cali Before You Dig No. L014 f Existing Water Su
- g W Supply: ❑ Public Water (]We11
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish
two copies of separate drawing This section to be filied out by
Indicate North Town of South Windsor
No. cuts
Est. Patch Size(s) sf
iEst. Pvt.Thickness in.
iEst. Patch Unit Price$ /sf
Est.Patch Cost$_-�
f3- Est. Curb Curb ReplacementTL
ft
Est. Curb Unit Price$ eft
Est.Curb Cost$
Est. Traffic Unit Cost$
Est.Traffic Control$
Amt.of Deposit$
Total Due
( )Cash ( )Check#
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 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:_
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