HomeMy WebLinkAboutStreet Cut Permits 571 Avery Street (2) 1600131 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 07/18/2016
GIS ID: 06300571 n6z FEE:
MUNIS APPLICATION# 201600974 y, z. 25.00
5 F�XPIRATION DATE: 07/18/2017
APPLICANT ' s�J
y LOCATION
NAME: MSR UTILITY MAINfENAN'CE CARP ADDTt�S ; `�S 1 A'.CRY STREET
ADDRESS: P O BOX 606 r OWNER JONESALEXANDER F JR&LYNN A
DUNSTABLE,MA(1118-
$7i A%RY STREET
PHONE �� : z a SUTIVINDSOR,CT 06074
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WORK DESCRIPTION: 2XTT7�C3E WETS INx.Cr�r ' I�EI� I `IQZ'II�1Sp CT A RECENTLY
INSAIYI EIS CAS 5� ){CE 4 �•
APPLICANT AGREES TO FURNISFI THFTOW `QF0.OUT�I'SINDSDR THE'AM4UXI�OF BND REQUIREb AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FORA INS RR $Y TIE T� 1 FbR JVIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TEE e4Pa in-ANTI 17 em
IND WZT L ASIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SQTJ�H V7IaiDSt?R-S STRtT CST`pE[MIT MANUAL.
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ISSUED BY DA`T INS x C' ED INSPECTED BY
7/181201610:15AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT Na.: 1600 CONTRACTOR: /
LOCATION: 5 -7
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TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: b4k - DATE:_ _/- "_/_7
5/molloy/forms 2014 Town of South Windsor INP5EC ON REPORT 14
Aer' koA'f'1. '04 'TV.l1 s"1. !.1'!CC 1 r-A%OA..V.A i tu. r.=ni,wei 1
,w!"Nom TO"OF SOUTH 10140SOK ;pubLIC iNOMS DEPARTMENT Permit Na,
dWN HALL: 1540 SUE.t„fVN AVENUE SQU>tH W!N[}SOl �CY 46ATa FED $25 Qt
Nara., of`Firrn 1; t o Y Rha�r a Na 10 -9 0(�0`2,
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address of Firm - Zip Cade ;
ta lion of proposed work
Describe fully natule of pormit requested
ICJ t +: r is
Starting date 4' GaII Before l�ou Di Nod ( ( �
PLEASE NaTE: THE DEPQSIT FQR Tf E PERfuli4NENT;F�AVI=iNENT PA7 CH AND.CUHB REPLACEMENT(S:R PRELIMINAR`(ESTIMATE. THE
APpLiCAI)iT.IS RE$PONSIBLE'FpFt THE 1=UL.L FINAL COST OF THE PEF.MiANENT PATCH AND QU,B:REF�LA 9ME3NT,f.CLUDING ANY
IIVr✓#EASES lN.PATCH AREA;CURB LENCTFI;:TAAFFiG CONT.,ROL AND.THE TQIhi1V'S CONTRACT-COSTS': TWE;PERMANENT::PATCH IS.:
TYPICALl;1�CQMPL>=TEq WITHIN A YEAi�O�THE TEfuIPORARY PATCH.BUT IT:000LO BE LAT�'rHAN A YEAR.
0 wk Appiioabie: Q`lVo I Ovgmeril,Cuib or Srdewali..Gut Pavement Cut Curb t Lit: 0 Sldcwslk Cu!
G] .Ekis#ing Driveway;No.Changes; C];.Proppsad i7tivetntay'U1Gidanirt 1.7: Propos.ed.Npw Driveway
water:Supply; O'`Pubkwater. CI Will Sewage daWjce ❑. PuEalic Sevye CJ.. Septip
Show sketch of proposed wont or furnish Indioate::North This sedtian to fill out by Town
two copes of$eparate drawing.
No.cuts
Est Put.Thickness...... . . . ,ink
1w.Patch U. it;P.r cti'$ 7sf
. Est,Pa#Ch Ca"st$
E4 Curb Replac,.aMent ft
Sit.'Curb Unit prlee.$ Ift
Est.Curb'Cost..$.'
Est.iSldewalk Replacement _s
ist Sldewa�I�;�ln <Prfce ...
Est..Sidewalk Cost. i.
Est:Traffic Hours bf
Es Itaffie Unittost:$•. 'r
Est.:Traffic Control$
:..... .... ...
DRIfIEWi1YS:n1u3t,Oo aft a po'to 11 om.t V-Prapaxty:.Nrle°:per` TO
tsi...Due:
section 2. x of t1►e=zoning regulations
[ ).Cash ,( )Check'#
Applican'tJ&responsibi®for oontactirtg the Police Dept and
PERMIT SHALL. KEPI QIN J08$iITE AT ALL TIMES P$Id.By.
I . .
i AGREE TO FURNISH TO'r11 TOWN OF SOUTH WINDSOR Tf..E AWlQtJ.e5fT C?F BCJ . REEiUiREq ANR TO ReI4 80HSE THE TOWN;QP&OiwJTH
Wlh1DSQR FQR ANY EXPENSES INC.tJRRED BY THE.TQWN FOR MAINTENANCE.OR REPAIR WORK IN£ONNECTIQlV W1TFI THIS PERMIT,�ND
�FHAT i AM I=AMILI�a WITH AND WILL ABIDE BY THE RLiLES ANb:REOULATIONS PERMITS AS.OUTL.I.NEI7 IN'THE TCiWN OF SQUTH
wiN.taSQR'S<; E . U.: RMIT MANUAL:
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