HomeMy WebLinkAboutStreet Cut Permits 10 Kellog Circle (4) 1500031 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 04/27/2015
GIS ID:49400010 -
MUNIS APPLICATION# 201500377 - FEE: 25.00
EXPIRATION DATE: 04/26/2016
APPLICANT t - - - LOCATION
NAME: ADVANCED CONSTRVkTION ,ADDI E r0 KEL& CIRCLE
ADDRESS: 5 CHESTNUT HILL Rd4r „OWNER PIORE*SSELL E&SUSAN S
STAFFORD SPRINGS,C`-`0F076i 40 XEC CIR
PHONE 860-519-8442 � TIC V& DSOR,CT 06074
WORK DESCRIPTION: INST)kLLJ—AIKCA'F
APPLICANT AGREES TO FURNISH THE 1 O WI�OF SOUTH WINDSOI TIIE AMOUNT O BO} D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES IN---- RED BY THE TOWI�1 FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH IPPLIGA - IS FAMILIAR WITH AMID,.WILD ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN ORSOUTH WINIDSOR'S STREE°I"CUT PERMIT MANUAL.
ISSUED BY DAT IN�P CTED INSPECTED BY
4/27/2015 12:34 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: }jaa ceod cc)aS'7-r
LOCATION: 10 Kg 11 D� e'1 c-I 'P
TYPE OF WORK:
DATE INSP.NEEDED: DATE INSP:
INSPECTED BY: i3D
WORK IN
PROGRESS: S%
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
1
INPUT: ` - DATE:
S/molloy/Porms 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 $25.00
Name of Firm Advanced Construction Engineering Service , LLC Phone No. 860 519 8442
Address of Firm 5Chestnut Hill Rd Stafford Springs CT Zip Code 06076
Location of proposed work
Describe fully nature of permit requested Kgall,Repair
Starting date / 1 2015 Call Before You Dig No .2_0C I 1�Q 472—
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: l# No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
0 No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
Est.Curb Cost$
Est. Sidewalk Replacement sf
Est. Sidewalk Unit Price
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 CUT PERMIT MANUAL.
Signed: Print Name Penman Ahmadi Date:`f/ab/ 2015
Street Excavation Permit 2014