HomeMy WebLinkAboutStreet Cut Permits 108 Hilton Drive 1300165 TOWN OF SOUTH WINDSOR, CT
'PERMIT NUMBER STREET CUT PERMIT
DATE: 07/10/2013 t ,
GIS ID;44100108 AL
a{ ,f FEE: 25.00
MUNIS APPLICATION# 201300956 IRATION DATE: 07/10/2014
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APPLICANT � � � 5 s LOCATION
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DRIVE
ADDRESS: P O BOX 71 �` � I= AIN1✓ LY EILEEN M
SOUTH WINDSOR, 1vON DRIVE
N �j � � TTIzV INDSOR,CT 06074
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WORK DESCRIPTION: DRI I
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APPLICANT AGREES TO FURNISH THE IV, .QUT=
CUE -c�5 �� A(A REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN � � AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH IAl4ITS W�AI ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OFQUf'IftI1SR TE �CgPER; TT MANUAL.
ISSUED BY DATA iIrTS ` ' TED INSPECTED BY
7/10/201311:47AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1 I fi
- CONTRACTOR:
LOCATION: 10 .,
TYPE OF WORK: Dc'
DATE INSP NEEDED. DATE INSP: ®t 1- `f�
INSPECTED BY: . 0
WORK IN .
PROGRESS:
SEPTIC TANK PUMPED, SMASHED,FILLED WITNESSED❑ YES ❑ NO
AS-BUILT:
DATE:.
S/FOPMS/TOWN OF SOUM WINDSOP INSPECTION
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 $25.00
Name o !rm o -�. one o• \ - —�--
Address of Firm ""�,o . r n �o>v��. \t'�' ov ��. _____ Zip Code
Location of proposed work
Describe sully nature of permit requested \�c�
Starling dale � �o��-� Approx. time for completion `a �, \ 4
Can Before You Dig No. ` ��3"a.`Z�4D� Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE, THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INt;LUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Snow Sketch of proposed work or furnish This s2otlQn e filled out b
!wo copies of separate drawing Indicate North TRwn of South Windsor
No.cuts
Est. Patch Size(s) si
Est. Pvt. Thickness in.
'Est. Patch Uhtt.Prfce$ rsl
I Est. Patch Cost$
b' Est, Curb Replacement ft
Est, Curb Unit Price$ /It
Est, Curb Cost $
Est.Traffic Unit Cost$ /hr
Est.Traffic Control $
Amt. of Deposll$
Total Due$
( ) Cash { )Check tE
Applicant is responsible for contacting Paid By
ine 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
PERMI UTLINED IN THE TOWN OF SOUTH WWD50R'S STREET CUT P RMIT MANUAL.
Signed ��7� '� _ Dale;
T;ue 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
Sueec Excavation Permit 08 REV 10.22.08