HomeMy WebLinkAboutStreet Cut Permits 1096 Ellington Road 1800163 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 10/25/2018 w,:
GIS ID: 30301096 V 4 FEE: 50.00
MUNIS APPLICATION# 201802109 IRATION DATE: 10/25/2019
APPLICANT
LOCATION
NAME: METROPOLITAN DISTRlT% INGTON ROAD
ADDRESS: 125 MAXIM ROAD v r QWNER E'VRI�NK
WtiBAV%STREET STE 21850
HARTFORD,CT 061141
PHONE r
WORK DESCRIPTION: BOX
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APPLICANT AGREES TO FURNISH THE TQk p NSOUTH WINDSC?R T Esw13y10UI T OI BONI QUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN �rtENSS WCURREDY THE TOWN F 1iM1IIr1TENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI 'Ml tlCAI fT IS FAMT�7AR WITH Al I7 W AI IDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN Ole SOUTH WINDSOR 9,�STREET C1UT:PERI;IIT'NIANUAL.
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ISSUED BY INSPECTED BY
10/25/2018 1:08 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPEECTION REPORT
PERMIT NO.: • l CONTRACTOR:
LOCATION: U `
TYPE OF WORK: & .
DATE INSP NEEpEDL, • -_._ . DATE INSP r /
INSPECTED BY:
WORK IN
PROGRESS: ' `
SEPTIC TANK PUMPED,'SMASHED, FILLED WITNESSED ❑YES a NU
AS-BUILT:
INPUT: L .. DATE:
S/mogoy/ftm tow Tm of South Windsor•WP9&rr M P001t'P t4
DAD-OZ9,Rev2n2 THE METROPOLITAN DISTRICT- PAVEMENT CUT DATE:
ADDRESS �. G� '� BILL JOB O YES G'106_ WO# S
CLOSEST STREET TOWN— ,'-, STATE HIGHWAY ❑YES ffO
DRAW SKETCH SHOWING LOCATION AND/SIZE OF CUTS AND CUT MADE IN
CROSS SECTION OF PAVEMENT
❑STREET ❑BITUM._" ❑CONC.-" CJPREMIX "
'❑SIDEWALK ❑eITUM. " ❑CONC._" ❑FLAG
El CURB ❑B(TUM._' ❑CONC._' ❑STONE_'
0DRIVEWAY ❑BITUM. ." ❑CONC. "
1 tGrASS LOAM&SEED NEEDED ESQ ❑NO
� REASON FOR CUT:
DEPTH OF EXCAVATION; / 5
° } NUMBER OF CUTS;
DATE OF FIRST CUT:
IS JOB COMPLETED: /15S ❑NO
/ � L FOREMAN: f_� (/f'•�'
REPLACEMENT PAVEMENT CONTRACT INC.:
BITUMINOUS ❑ CONCRETE❑ PREMIX 0
DATE COMPLETED'^
ACCOUNT NUMBER:
CALCULATIONS
OF CUT ITEM# JTEM# ITEM# ITEM
PAVING INSPECTOR CONTRACTOR
(OR GINAL) (YELLOW)i