HomeMy WebLinkAboutStreet Cut Permits 165 Valley View Drive (2) 1500270 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 11/3 0/2015
GIS ID: 91200165 FEE: 0.00
MUNIS APPLICATION# 201501753 EXPIRATION DATE:
APPLICANT LOCATION
NAME: CONNECTICUT WATER COMPANY ADDRESS: 165`VALLEY VIEW DRIVE
ADDRESS: 25 NORTH ROAD OWNER: BASSETT JENNIFER M&
EAST WINDSOR, CTb&M I65 -VALLEY VIEW DR
SOUTH WINDSOR,CT 06074
PHONE 860-623-3355
WORK DESCRIPTION: EMERGENCEY 8" CIP WATER MAIN BREAK
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYE XPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WIND R'S TREET CUT PERMIT MANUAL.
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ISSUED BY DA E SPECTED SPECTED BY
1 1/30/201 5 9:55AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: 1����a�7[�' CONTRACTOR:
LOCATION: V
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: C J1 n I,1't t`C V cw
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: J
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl.`N- -TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT : Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074 FEE $25A0
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rit .Niil l -av At
Phone No.-16
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°Address Of Fitffte ► ' /'d -G ,•. .�1 Ot fU b'8°
Location of proposed Ad dam/
ips ^
# - Describe fully nature of permit reqst u8
Starting + P 'I Call Before You Dig No dc�l�'�'?t 5" t i t t�
�ia ;'PLEASE NOTE: THE}DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE, THE
,(} -`-} 'APPLICANT IS RESPONSIBLE,FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
`INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS.<THE PERMANENT PATCH IS
TYPICALLY COMPLETED-WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
p is Check Applicable: ❑ No Pa#ement,Curb or Sidewalk Cut Pavement Cut El Curb'Cut ❑ Sidewalk Cut _
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if.j l= ❑ Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
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€`E1Ii*r;W+Ri19i .t�i iW,`44}. W so or ,•,e�..4[ -
l .,
l , F Show sketch of proposed wor�or furnish North ,.This section to be filled out by Town
I }il 'two copies of separate drawing
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Est. Patche s#
s --
a Est. Pvt.Thickness in.
Est.Patch Unit Price$ isf
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Est c Patch Cost$
Est.Curb Replacement
i Est.Curb Unit_Price$ /ft
.Cur
b rb Cosh
If
Est.Sidewalk Replacement sf
I Est,Sidewalk Unit Price
# -
, � Est.Sidewalk Gost
#" !Est.Traffic Hours I r
Est.Traffic Unit Cost$ hr
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,I�I 'i" i [► z �r} ;• •I 7> Est.Traffic.Control,
t Amt.;of Deposit$
Total Due,
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( }Cash' { }Check#
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i,t = .Applicant is responsible for contacting the Police Dept.and C.B.Y.D
f l IllPERMIT SHALL BE KEPT ON 4OBSITE AT ALL TIMES Paid By71
,
',I AGREE
'TO FURNISH TO THE-TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED ANDtTO';REIMBURSE THE TOWN OF SOUTH
WINDSOR_FOR ANY:EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND
• I "TI4ATWAM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
l l{r NWINDSOR S STREET CUT PERMIT-,MANUAL.
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