HomeMy WebLinkAboutStreet Cut Permits 5 Autumn Drive (2) 1400348 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 12/22/2014
GIS ID: 06000005 FEE: 25.00
MUNIS APPLICATION# 201401816 EXPIRATION DATE: 12/22/2015
APPLICANT LOCATION
NAME: ADVANCED CONSTRUCTION ADDRESS:` 5 ALITUMN DRIVE
ADDRESS: 5 CHESTNUT HILL ROAD; OWNER: STEVENS EDWARD B&SUELLEN
STAFFORD SPRINGS,CT 06076 5 AUTUMN DRIVE
SOUTH INDSOR,CT 06074
PHONE 860-519-8442
WORK DESCRIPTION: INSTALL REPLACE CATV
APPLICANT AGREES TO FURNISH 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 THE APPLICANT IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S ST ET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
12/22/2014 2:43 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: 4 d ode?qol
LOCATION: } t u M
TYPE OF WORK:
DATE INSP.NEEDED: DATE INSP: 313
INSPECTED BY:
WORK IN
PROGRESS: .4jv..,c-Ql �c. �h- ? "r- sCATV
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 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 $25.00
Name of Firm Gy� 'cj r rr Phone No. G� �C/
Address of Firm�, Ch E�t-n r,r h ' \ r� v S. r,���CL S. ��P 44 s, -r- Zip Code
Location of proposed work n I �
Describe fully nature of permit rec�uested� .}�„ I I y�E, n!c� P
Starting date Approx. time for completion
Call Before You Dig No. Existing Water Supply: ❑+611 'Water
❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish
two copies of separate drawing This section to be filled out by�
Indicate North Town of South Windsor II
No. cuts
Est. Patch Size(s) sf
Est. Pvt. Thickness—_ in.
Est. Patch Unit Price
Est. Patch Cost$
Est. Curb Replacement _ ft
Est. Curb Unit Price$ eft
Est. Curb Cost$
---
Est. Traffic Unit Cost$ _ /hr
iEst.Traffic Control s __
Amt.of Deposit$
Total Que$
( ) Cash ( )Check#
Applicant is responsible for contacting 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: /�) Date:
Title: DrivA Lice se#:
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 ExcavatJon Permit 08 REV 10-22.08