HomeMy WebLinkAboutStreet Cut Permits 67 Bourbon Street (3) 1500099 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/02/2015
GIS ID: 12300067 FEE: 25.00
MUNIS APPLICATION# 201500642 PIRATION DATE: 06/01/2016
APPLICANT = LOCATION
NAME: ADVANCED CONSTRi7CTIC6N "A1DIES - ` 6UIBON STREET
ADDRESS: 5 CHESTNUT HILL RCAI C}WNER F1 LAVI LLITA ROBERT F&SUSAN M
STAFFORD SPRINGS-0T---06076t?URBON STREET
ah
SOUTI WNDSOR,CT 06074
PHONE 860-519-8442if
WORK DESCRIPTION: INSALL PAD
AIR GATE
APPLICANT AGREES TO FURNISH THE*WN�F S(SUTH WINDSOR THE AMOUNT OE BOVI)REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANV&.&3 TENSES INCIJRREI6:BY IH TOWN OkM INTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI APPLICANT IS FA-MIL =WITH AND V�ILL-ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN( SOIJ H WINIISOR'S STREE 1 CUT 1' RIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
6/2/2015 10:06 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:.: CONTRACTOR: 1164 W96�
LOCATION: 67
TYPE OF WORK: l A5-\u lA
DATE INSP NEEDED: DATE INSP: rz ca
INSPECTED BY: '�'
WORK IN
PROGRESS: ,,,-L-t
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C, DATE:
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00
Name of Firm Advanced Construction Engineering Service , LLC Phone No. 860 519 8442
Address of Firm 5Chestnut Hill Rd Stafford Springs CT Zip Code 0607E
Location of proposed work Q LA ��5t
Describe fully nature of permit requested Install,Repair
Starting date 196 1 2015 Call Before You Dig No
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: EU No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
0 No.cuts
Est. Patch Size(s) sf
Est. Pvt. Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
Est. Curb Replacement ft
C7 Est. Curb Unit Price$ /ft
Est.Curb Cost$
Est. Sidewalk Replacement sf
Est. Sidewalk Unit Price$ /sf
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est. Traffic Unit Cost$' /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( ) Cash ( ) Check#
Applicant is responsible for contacting the Police Dept. and C.B.Y.D
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES 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 PERMIT MANUAL.
Signed: )( — Print Name Peiman Ahmadi Date:6/) / 2015
Street Excavation Per it 2014