HomeMy WebLinkAboutStreet Cut Permits 40 Skyline Drive (2) 1400093 TOWN OF SOUTH WINDSOR, C 1
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/01/2014
GIS ID: 83100040 FEE: 25.00
MUNIS APPLICATION# 201400479 "EXPIRATION DATE: 05/01/2015
APPLICANT % LOCATION
NAME: ADVANCED CONSTUTION ADDRESS: 40,-SKYLINE DRIVE
ADDRESS: 5 CHESTNUT HILL R9AD OWNER: lY1IZENR JESSICA&
STAFFORD SPRINT Q6076 40 SKYLINE DRIVE
Soull Windsor, CT 06074
PHONE 860-519-8442 = =
WORK DESCRIPTION: INSTAL,REPLACE CATV ,
APPLICANT AGREES TO FURNISH THRT OW-N OF SOUTH--WINDSOR THE AMOUNT OF I$OND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A f XPENSES INCURRED-BY THE TOWN FOR"IvIAINTENANCE 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 WINDSR'S STREET CUT PERMIT MANUAL.
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ISSUED BY DATE INSPECTED INSPECTED BY
5/1/2014 10:49 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /q j2na43 CONTRACTOR: AdUanc ect Cons` Z .
LOCATION: 'y 0 S Y_u Cqr p �r�v
TYPE OF WORK: m \/
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: tap
WORK IN
PROGRESS: r�place� c 4T✓ i`..i
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
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
f FEE $25.00
Name of Firm a Gy� ' 1 r S f�o 5 f i 6) S
- Phone NO. ,-j Z/0
Address of Firmer Ch ESt'n r,t h '�\ / �-k-r p-p�o(g P LLti��r�T Zip Cod
e
Location of proposed work
Describe fully nature of permit requested_ . � I i /V P n f n r
C) C� 11 VI - ���
Starting date �/2-f Approx. time for completion ✓
Call Before You Dig No. . , Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish
two copies of separate drawing This section to be filfed out by
Indicate North Town of South Windsor
No. cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
1 Est. Patch Unit Price$ /sf
i 1
Est. Patch Cost$_ -
_ Est. Curb Replacement
ft
-- Est. Curb Unit Price$
Est.Curb Cost$
Est.Traffic Unit Cost$
Est.Traffic Control$
Amt.of Deposit$
Total Due$___.�.�
( )Cash OCheck#
Applicant is responsible for contacting Paid By!^
the Police Dept.and C.B.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 PERMITAND 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.
9
Signed: V 1 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