HomeMy WebLinkAboutStreet Cut Permits 9999 Pepin Place (2) 1400112 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/12/2014
GIS ID: 70709999 FEE: 25.00
MUNIS APPLICATION# 201400547 EXPIRATION DATE: 05/12/2015
APPLICANT = LOCATION
NAME: SIMSCROFT ECHO IrARMS ADDRESS:' 009 P:EPIN PLACE
ADDRESS: P O BOX 581 OWNER: TO SOUTH WINDSOR
SIMSBURY, CT 06070 1540"SULLIVAN AVE
SOUTH WINDSOR, CT 06074
PHONE 860-651-0231
WORK DESCRIPTION: SANITARY MAIN EXTENSION WITH NEW SMH FOR SOUTH WINDSOR WOODS
APPLICANT AGREES TO FURNISH 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 THE APPLICANT IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN bF SOUTH WINDSR'S;/STREET CUT PERMIT MANUAL.
ISSUED BY -DATE INSPECTED INSPECTED BY
5/12/2014 3:55 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO-; I qO 0 1/.2 CONTRACTOR:
LOCATION: �1999. i°ef'�L Plac So lck`,••�' r t t,
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 0
WORK IN
PROGRESS: �, ���� ;�s ,� �- - o
4 s� �'g'c�� .s.-r-c-.d' Gad
v
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: } DATE:
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appi. No. TOWN OF SOUTH,WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00
Name of Firm -tt .a -� �.-� ��- Phone No.c 45um Ca.Sg- 3C.a_`13
Address of Firm,? -ta y;C����.S� n..�-bs r , c-T Zip Code
Location of proposed work /s�s�n,`4 1� I1t�i �Q•�i •tS o ���
Describe fully nature of permit requested S n� �fr�/✓i�,h A>J�S1.M 4/ n eW/
qyAq
Starting date Call Before You Dig No t&tA
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
171 Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
j t No.cuts L
Est. Patch Size(s) sf
P'C I t4 `, LA I g, Est. Pvt.Thickness in.
Sl/i G O ft V/j rG^ ��� j Est. Patch Unit Price$ /sf
Mew
Patch Cost$
/
V Gw SGtt lk Est.Curb Replacement ft
Est. Curb Unit Price$ /ft
4G Est.Curb Cost$
Q Est.Sidewalk Replacement sf
41% P A��'� v , W 1,0116 Est.Sidewalk Unit Price
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
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 UT PERMIT A A
Sign Print Name /AL�.�u �rl Date:
Str vation Permit 2014