HomeMy WebLinkAboutStreet Cut Permits 9999 Kelly Road (5) 1100075 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 07/06/11
GIS ID:49509999 = -
MUMS APPLICATION# 201100703 - = FEE: .00
EXPIRATION DATE: 07/05/12
APPLICANT LOCATION
NAME: GLENN DRILLING ADDRESS: KELLY LOAD
ADDRESS: 532 NEW LONDON KOZ' p4EI ; - S{)UT WINDSOR TOWN OF
COLCHESTER,CT 06415 1827 1540SULt,IVAN AVE
PHONE 860-537-3601 -S WINDSOR,CT 06074
WORK DESCRIPTION: TESIyPI ON,WATERIVIAIN FOR KELLYRAD -FOIE KELLY ROAD
RE C ON ST RUC TIOI PRC)3ECT="
APPLICANT AGREES TO FURNISH THE TOWN-0F OUTII WJNDSOR THE AMOU1 T dF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYEXPENSE INCURRED Bi'THE TGWN FORIVIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI APPLI"GANT I FAMILIAR WIT-i ANDS WII;L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSI2'S STREE CUT PEIIIT MANUAL.
ISSUED BY DATE INSPECTED 7iP (CTED BY
7/6/201111:06AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: i f 000 7S CONTRACTOR: C I e irl n 16 1 �
LOCATION: V-e I l U [ Q�� P C ✓1 ®-� 1�GQ
�J
TYPE OF WORK: em (I � 1 Y1
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: JS P
WORK IN
PROGRESS:___ (rive er�r�a �`r�iD
SEPTIC TANK PUMPED, SMASHED, FILLED ti//,�s, WITNESSED ❑ YES ❑ NO
AS—BUILT: "A
INPUT:_ DATE:
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W12007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC.WORKS DEPARTMENT
-1640 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Fi Phone No. b o
Address of Firm � a -
Zip Code C6Lji :
Location of proposed work 1
Describe fully nature of permit requested
Starting date 72 13.a i Approx.time for completion
Call Before You Dig No._30 11 o?O 3J_�O Existing Water.Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE-FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,-TRAFFIC.CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch_of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
A)O Fee No.cuts
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est:Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
AmL of Deposk$
Total Due$
O Cash { )Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.B.Y.D.
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
PERMIT S OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date_,. Q0 l
._. L_L_L�1
Title. Far`M c3-v1 Driver's License#: O -Sir
9 j O y 0 L'
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OF PERMIT
WORK MAY NOT BEGIN UNTIL A PERMIT HAS SEEN ISSUED
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PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08 REV 10-22-08 ¢