HomeMy WebLinkAboutStreet Cut Permits 73 Sycamore Road (3) 1700214 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/03/2017
GIS ID: 88800073
FEE: 50.00
MUNIS APPLICATION# 201701364 EXPIRATION DATE: 10/03/2018
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APPLICANT? w LOCATIQN
NAME: QUALITY PAVING 0`O.; ADDRESS 'I3�'YdAMORE ROAD
ADDRESS: 194 S.MAIN STREET OWNER 1�TEWT6N' KENNETH P&AMY M
EAST WINDSOR,C, 0608 7 MORE ROAD
{` <SbiJTHWINDSOR, CT 06074
PHONE 860-523-4I82
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WORK DESCRIPTION: DR w 1pwAY z
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APPLICANT AGREES TO FURNISH THI4TONbrA.Z�F SOU3H W1NDSt7TZ THE AM0[71 P 01?BAND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN .EFENSES INC>3R1ZED BY I FIE TQWNEFOR1vIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APIICAI�[T IS FAMILIAR WITH AND}4yz1JL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN f1F S%OUTH WINDS OR!S STREET CUT P„EItMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
10/3/201712:12PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 12 00 LW CONTRACTOR: Q u 03 i
LOCATION: IS m ock
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: /o rep
INSPECTED BY: 6)
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT: '
INPUT: "' DATE:
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm q Phone No.
Address of Firm Zip Code 4�1� e
Location of proposed work
Describe fully naturee of permit request , u,
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Starting date 3 Approx.time for completion
-
Call Before You Dig No. / 39 '/ Existing Water Supply: ❑ Public ter ❑Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH 1S TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish ;,this section to be filled out by
two copies of separate dr wing Indicate.North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
ty Est. Pvt.Thickness in.
Est. Patch Unit Price
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price.$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ mr
I Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.B.Y.D.
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 CUT PERMIT MANUAL.
Signed: L�C!z1'm Date: !
Title: Driver's License#:
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OF PERMIT
WORK MAY NOT BEGIN UNTIL A PERMIT HAS BEEN ISSUED
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08 REV 10-22-W