HomeMy WebLinkAboutStreet Cut Permits 5 Autumn Drive (3) 1400348 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 12/22/2014
GIS ID: 06000005
MUNIS APPLICATION# 201401816 FEE: 25.00
EXPIRATION DATE: 12/22/2015
APPLICANT LOCATION
NAME: ADVANCED CONSTRUCTION ADDRESS 5 AUTUMN DRIVE
ADDRESS: 5 CHESTNUT HILL ROAD` OWNER: STEVENS EDWARD B&SUELLEN
STAFFORD SPRINGS,CT 06076 5: _
AUTUMN DRIVE
SOUTH WINDSOR,CT 06074
PHONE 860-5194442
WORK DESCRIPTION: INSTALL REPLACE CATV
THE DRAIN LAYER ASSIGNED TO THIS PERMIT HAS A VALID LICENSE ISSUED BY THE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTH IN THE ATTACHED`CONDITIONS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED IN ECTED BY
12/22/2014 2:46 PM
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I'V eOSY� CONTRACTOR:
LOCATION: MV/I"/I�V_V)�—�
TYPE OF WORK: I�I
DATE INSP.NEEDED: DATE INSP: A 1t5
INSPECTED BY:
WORK IN
PROGRESS: ---9 JbvA, s ., r�la v
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: ON- 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 $25.00 C n
Name of Firm 'A Gy� ' r o y Phone No.—R�7 ) 1 % ���L�
Address of Firm f� C.h A-t�� ��7(S��.�i1� ,T
.1 �1� Zip Code
Location of proposed work `
Describe fully nature of permit requested
Starting date Approx, time for completion
Call Before You Dig No. � ck
Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish �-
two copies of separate drawing This section to be filled out bv�
Indicate North Town of South Windsor
No. cuts
Est. Patch Size(s) sf
Est. Pvt. Thickness in.
Est. Patch Unit Price$_ /sf
Est.Patch Cost$.. .
Est. Curb Replacement
Est. Curb Unit Price$ /ft
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: �IGGV Date: /`2
Title: l
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 Excavatlon Permit 08 REV 10-22-08