HomeMy WebLinkAboutStreet Cut Permits 703 Nevers Road (2) 1500250 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/20/2015
GIS ID: 62400703 FEE: 25.00
MUNIS APPLICATION# 201501496 - EXPIRATION DATE: 10/19/2016
APPLICANT LOCATION
NAME: ADVANCED CONSTRUCTION ADDRESS: 703NEVERS ROAD
ADDRESS: 5 CHESTNUT HILL ROAD OWNER: KING ROGER&MARY S
STAFFORD SPRINGSCT:06076 703 NEVERS ROAD
SOUTH WINDSOR,CT 06074
PHONE 860 514-8442-
WORK DESCRIPTION: 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 FORTHIN THE ATTACHED`CONDITIONS'. ALL WORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,ALL OSHA REQUIREMENTS,AND THE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
10/20/2015 11:41 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: /S'O 0aS0 CONTRACTOR: A d d4 in(sa oL
LOCATION: 103
TYPE OF WORK: C,A -f
DATE INSP NEEDED: DATE INSP: s-
INSPECTED BY: h
WORK IN •
PROGRESS: GATv' L
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED 0 YES ❑NO
INPUT. C .JA DATE: 1
S/molloy/forms 2014 Town of SOA Windsor IMPSEMON 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 $25.00
Name of Firm Advanced Construction Engineerinq Service , LLC Phone No. 860 519 8442
Address of Firm 5Chestnut Hill Rd Stafford S rin s CT Zip Code OR076
Location of proposed work
Describe fully nature of permit requested Install,Repair
Starting date Call Before You Dig No
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: I# No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No. cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
Est. Curb Cost$
Est. Sidewalk Replacement sf
n0j]
Est. Sidewalk Unit Price
Est.Sidewalk Cost$
Est. Traffic Hours hr
Est. Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
Applicant is responsible for contacting the Police Dept. and C.B,Y.D ( ) Cash ( ) Check
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. l
Signed: Print Name_ Peiman Ahmadi Date:�IO/ IO/ 2015