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HomeMy WebLinkAboutStreet Cut Permits 871 Ellington Road (2) 1400166 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER STREET CUT PUBLIC UTILITY DATE: 06/12/2014 GIS ID: 30300871 FEE: 0.00 MUNIS APPLICATION# 201400757 - pIRATION DATE: APPLICANT G LOCATION NAME: METROPOLITAN D TRICK "AEI INGTON ROAD ADDRESS: 125 MAXIM ROAD NDEASON ROGER H&DONNA S HARTFORD,CT 06 F1 f� i % 8 TLtINGTON ROAD At i PHONE r � or -�9UT-H INDSOR,CT 06074 Vati WORK DESCRIPTION: RE WNrR` 5 f APPLICANT AGREES TO FURNISH THETO, OPOUTTL 1D y � AMQTr� $AND REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH WINDSOR FOR AIRYXB I � DAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND TF* 1' ICANT IR III WIY L ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN(F 5611 TVTFIIIT MANUAL. ad ISSUED BY Dl CTED INSPECTED BY 6/12/2014 11:05 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** vs f sg if i - i - %% ii, �/- i.. i / ,/ , %� �� i TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: CONTRACTOR: /col J)C LOCATION: TYPE OF WORK: f ej la/p e-x i�t i r)Q I. V (aar k9 I D Sao g i q q-, DATE INSP NEEDED: DATE INSP: l 2 INSPECTED BY:* � WORK IN n PROGRESS: 4 t" SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO AS-BUILT: INPUT: DATE: J G S/2014 Town of South Windsor INPSEMON REPORT 14 APPLICATION FOR STREET EXCAVATION PERMIT Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No. TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR,OT 06074 FEE $25.00 ame of Flrm I L I�f I� t 5 T�Ir CT- Phone No. �1�0. 11 0 Address of Firm 12$ MAY( I zip Code- ! Location of proposed work "� �� � Describe fully nature'�f�e�rmi�requested rr�4 Starting date - 0 w Call Before You Dig No 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. Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut A Pavement Cut A Curb Cut ❑ Sidewalk Cut El Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic Show sketch of proposed work or furnish Indicate North Itis section to be filled out by Town two copies of separate drawing 0 No.cuts Est.Patch Size(s) sf Est.Pvt.Thickness in. Est.Patch Unit Price$ /sf Est.Patch Cost$ Est.Curb Replacement ft Est.Curb Unit Price$ /ff Est.Curb Cost$ Est.Sidewalk Replacement sf Est.Sidewalk Unit Price$ /sf Est.Sidewalk Cost$ Est.Traffic Hours hr Est.Traffic Unit Cost$ /hr Est.Traffic Control$ Amt.of Deposit$ Total Due$ Applicant is responsible for contacting the Police Dept.and C.B.Y.D ( )Cash ( )Check# PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Paid By 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 PA!F�AL l D WILL ASIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSE IT NUAL. f� f /Signed: ��JVPrint Name JO f tj t M 1* Date: 6.1© rrStreet E014