HomeMy WebLinkAboutStreet Cut Permits 74 Rugby Lane (2) 1500035 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 04/27/2015
GIS ID: 78000074 FEE: 25.00
MUNIS APPLICATION# 201500381 EXPIRATION DATE: 04/26/2016
APPLICANT LOCATION
NAME: ADVANCED CONSTRUCTION ADDRESS: 74 RUGBY LANE
ADDRESS: 5 CHESTNUT HILL ROAD OWNER: LUXEMBURG MAURY R&SUSAN
STAFFORD SPRINGS,CT 06076 14 RUGBY LANE
SOUTH WINDSOR, CT 06074
PHONE 860-519-8442
WORK DESCRIPTION: INSTALL REPAIR CATV
APPLICANT AGREES TO FURNISH 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 THE APPLICANT IS 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.if
ISSUED BY DATEINSPECTED INSPECTED BY
4/27/2015 4:01 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:_/I®Yn3�L . CONTRACTOR: cofq-5 Vf
LOCATION: Ev6& b
TYPE OF WORK: -
DATE INSP.NEEDED: DATE INSP:� j 4 i�
INSPECTED BY:
WORK IN
PROGRESS: T) -�
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: - DATE: / S
S/moiloy/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 $25.00
Name of Firm Advanced Construction Engineering Service , LLC Phone No. 860 519 8442
Address of Firm 5Chestnut Hill Rd Stafford Springs CT zip Code 0607R
Location of proposed work�L� R (A aA"bIA CIO
Describe fully nature of permit req ted l Stall,Repair
Starting date / / 2015 Call Before You Dig No 1 O 2_
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: E4 No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
0 No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Ell 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 W L ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDSOR'S STREET CUT PERMI NUAL.
Signed: Print Name Peiman Ahrnadi DateQ )%/ 2015
Street Excavation Permit 2014