HomeMy WebLinkAboutStreet Cut Permits 56 Perrin Lane (2) • 1500247 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 10/20/2015
GIS ID: 70900056
MUNIS APPLICATION# 201501491 FEE: 25.00
EXPIRATION DATE: 10/19/2016
APPLICANT LOCATION
NAME: CENTRAL SEALING_CO INC ADDRESS: 56--PERRIN LANE
ADDRESS: 5 ARROW WOOD CIR-- _ OWNER: FIELD E THOMAS&MAUREEN H
SOUTH WINDSOR,---'CT 06g74 56 PERRIN LANE
PHONE SOUTH WINDSOR, CT 06074
WORK DESCRIPTION: DRIVEWAY
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WINDSOR THE AMOUNT OF 13OND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYEXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT IS FAMILIAR WITH AND W L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OFSOUTH WINDSORS STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
1 0/20/201 5 9:08AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
- --------- ---- - -- --- - ----- ------
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: CONTRACTOR: CfA`MG !i4t
LOCATION: .S IP�r r 8 r1
TYPE OF WORK:_ Z�
DATE INSP NEEDED: DATE INSP:�a " i
INSPECTED BY: �n
WORK IN
PROGRESS-, D 5.4k
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED YES ❑ NO
AS-BUILT:
INPUT:
DATE.
SIWIOY/forms 2014 Tom of South andw MPSMMN 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,CT 06074 FEE $25.00
Name of Firm Cer-tifi-A) s&a i" C o ( Ph ne No. %� ?-Eq ^7�Q b
Address of Firm I SD S V11 SP+ R061Z knVe-- a S Zip Code n
Location of proposed work p Pe r ( La Ke... �^
Describe fully nature of permit requested r�.rrti y a n �e p G{GQ G�C)74 L� d r! VetcJCLt
Starting date tD I Call Before You Dig No 1
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est.Patch Unit Price
Est.Patch Cost$
i3
Est.Curb Replacement ft
i� Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Sidewalk Replacement sf
Est.Sidewalk Unit Price
X 1 Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
1 X zO' Est.Traffic Control$
c Amt.of Deposit$
J
I �'� ��a �1 �► '!� r l t' F Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting the Police Dept.and C.B.Y.D
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 AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDSOR'S STREET CUT ERMIT MANUAL. I _
Signed: �' Print Name �� t ) erh Z Z► Date: IV
Street Exca,47on Permit 2014