HomeMy WebLinkAboutStreet Cut Permits 9999 Slater Street (3) 1200116 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/29/12
GIS ID: 83409999 ,- FEE: 00
MUNIS APPLICATION# 201200854 EXPIRATION DATE: 06/29/13
APPLICANT _ LOCATION
NAME: DOUBLE C CONSTRUCTION LLC ADDRESS: 9999 SLATER STREET
ADDRESS: P O BOX 785 = QWNER. TOWN OF SOUTH WINDSOR
45 EVANS ROAD f = 1540=DUI LIVAN AVE
ROCKY HILL,CT 06067 = SGUTH WINDSOR CT 06074
PHONE
WORK DESCRIPTION: RECONSTA. UU LA I R ST Ii1ZOM b IIIING ST TO OAKLAND RD
TOWN PROJECT NO FEES
APPLICANT AGREES TO FURNISH THE IOWN OF SOUTH 4VINDSORTHEAMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN3'I XI'ENSES INCURRED"$Y,THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THIS APPI ICANT IS FAMILIAR WITH-AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINI�SR'S 5TREI T-CUT PERMIT MANUAL/ & L
ISSUED BY DA E INSPEC ED INSPECTED BY
6/29/20128:31AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
r
@01a00A_S4_ APPLICATION FOR STREET EXCAVATION PERMIT ldy0l/,6 .
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
sltiaf, 54 PUBLIC WORKS DEPARTMENT
P 0-ce l P3'to999y 1640 SULLIVAN AVENUE Date: _l
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm 00 0 W e Phone No. UP 0-L 3.4 - o 4 S-5-
Address of Firm x 714 Zip Code 6Ar0'7 c/
Location of proposed work cc -ec- t1�.,
Describe fully nature of permit requested 'r--x eci v. e54 0 h l(c,J10 h
S ,G b a i r%
-to {s -k e vvA e-,%4
Starting date — — / Approx.time for completion Iry U t�c•v S
Call Before You Dig-No. 019-- S-00I I r Existing Water Supply: []'Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE:,THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST.OF THE
P-ARMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
L% GTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
CC�%,ETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketcliYof proposed work or furnish This section to be filled out by
two copies o eparate drawing Indicate.North Town of.South Windsor
p
PI oJtc� - P tr 1 'ate No.cuts
Town Pro#ed - no (e-0s
Est.Patch Sizes) sf
01
'a Est.Pvt.Thickness in.
,e (i Est.Patch Unit Price$ '" /sf
O Es Patch Cost$
Zi Iry Est.Curb Replacement ft
Est.Curb Unit Price$ fft
i Est.Curb Cost$
,1 U Est.Traffic Unk.Cost$ J fir
Est.Traffic, troll$
Amt.of:DOM $
TotaH)ue$
U ( )Cash ( j Check#
07
ApAnt s responsible for contacting PaidZy
the Poli2R.Dept.and C.S.Y.D.
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 1 AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLINED OWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: �,7j Date-, �e) 9` &1
Titlet, Driver's License#: /a 9L a-S
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