HomeMy WebLinkAboutStreet Cut Permits 47 Darlene Drive (2) 1500034 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 04/27/2015 "
GIS ID:25500047 _ FEE: 25.00
MUNIS APPLICATION# 201500380 EXPIRATION DATE: 04/26/2016
APPLICANT/ LOCATION
NAME: ADVANCED CONSTRuf TION ADDI E�� 4 ARLENE DRIVE
ADDRESS: 5 CHESTNUT HILL R( AF f 0V ER A LER EORI R
STAFFORD SPRINGS,Cf'-06B76 = 47 L NE DRIVE
SOUTH VINDSOR,CT 06074
PHONE 860-519-8442
WORK DESCRIPTION: INSTALL EPA�R CATS
APPLICANT AGREES TO FURNISH THE-I)QWN;�F SOUTH IND OR L EAM�5LI1 T(?P B01D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY El--ENSFS Ii�CI TRRR 13�`"I TO fi OI I INTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI APp4fjcrANT IS RAMIE IAI2=WIT1 ANI WTL -ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OFSOUT WINDSORs -STREET CUT PERItIIT MANUAL,.
ISSUED BY DATE INSPECTED INSPECTED BY
4/27/2015 2:24 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I.� ��% CONTRACTOR:
LOCATION: G/
A
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: P t
WORK IN
PROGRESS: J-
L
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: Imo- DATE:
S/molloy/forms 2014 Town of South Windsor INPSELMON 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 $25.00
Name of Firm Advanced Construction Engineering Service , LLC Phone No. 860 519 8442
Address of Firm 5Chestnut Hill Rd Stafford Springs CT Zip Code 06076
Location of proposed work 44':l I)CAr(letl-e- ►lam'
Describe fully nature of permit requested Install,Repair
Starting date / / 2015 Call Before You Dig No
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: A No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No. cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in,
Est. Patch Unit Price
Est. Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
Est. Curb Cost$
Est. Sidewalk Replacement sf
Est. Sidewalk Unit Price
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
O 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 Pejman Ahmadi Date:'f /--W 2015
Street Excavation Per it 2014