HomeMy WebLinkAboutStreet Cut Permits 76 Sally Drive (2) 1400212 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 07/21/2014
GIS ID: 79500076 FEE: 25.00
MUNIS APPLICATION# 201400982 iaPIRATION DATE: 07/21/2015
APPLICAIsfff— _ = LOCATION
NAME: ADVANCED CONSTRUCTION ADDI 137& A , DRIVE
ADDRESS: 5 CHESTNUT HILL bD OWN RR: FVIN4 LAWRENCE&LAURA L
STAFFORD SPRINS,CT Q60?6 ` _ fib SILLY DRIVE
�4�UTI;WINDSOR,CT 06074
PHONE 860-519-8442
l _ _
WORK DESCRIPTION: INS`TA L REPS A.CE�A I V ,
APPLICANT AGREES TO FURNISH THE--T0. ?I�I t�F SOUTH WINDS()R THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AY_= PENSES INC[7RREDBY THE TOWN-FOLt1�1AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TFE APPLICANT IS FAMILIAR WI7 H AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSR'S-STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
7/21/201411:21AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I ql)Od/� CONTRACTOR: tdl1Q0 _ C420S
LOCATION: 76
TYPE OF WORK: ii CATW
DATE INSP NEEDED: DATE INSP:--2.1 Idlu
INSPECTED BY: 3 3b
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: - -
S/2014 Town of South Windsor INPSEMON 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 $25.00
Name of Firm '�Gyl ' I r
Address of Firm Se V Phone No. -519
de
Location of proposed work Q S " �� Zip Co
Describe fully nature of permit requested`
Starting date_
Approx. time for`f
completion �`
Call Before You Dig No. 7 t 2-7,a, t c_ Existing Water Supply: ❑ Public Water
❑Well
Existing Sewage Service: ❑ Public Sewer
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS Septic
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish
two copies of separate drawing This section to be filled out Indicate North Town of South Windsor
No. cuts
0
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$ _
Est. Curb Replacement ft
Est. Curb Unit Price$___/f
Est.Curb Cost$
Est. Traffic Unit Cost$
Est.Traffic Control$ f
Amt.of Deposit$
Total
( )Cash OCheck#
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:_11 f
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