HomeMy WebLinkAboutStreet Cut Permits 45 Brian Road (2) 1600090 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/06/2016 pFv
GIS ID: 13500045 r r ,F { L FEE: 25.00
MUNIS APPLICATION# 201600733 � r 3 �a VXPIRATION DATE: 06/06/2017
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APPLICA LOCATION
NAME: QUALITY PAVING yFx ADDR>rxSS �x A uBR N ROAD
ADDRESS: 194 S.MAIN STREF ' r < '�4 titF�� k�(SWNFR' Yk �ERICICON WILLIAM&SHARON M
EAST WINDSOR,C O r� 6S s � u`{ i I IX N ROAD
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t � s SOUTH VINDSOR,CT 06074
PHONE 860-523-4182 � r
WORK DESCRIPTION:
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APPLICANT AGREES TO FURNISH TH�T0 1`CIF Oi 5 V�I) �E AMq-VIi l�Or tMND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A I E PLN I" I F11� 1Ii'S %-F TGrW F{�jI MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND I 'API ICAI�IMF ZIyR wl�rl, r �4YILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO WN Sf�YJ T II1CFI�7SR'Fa wTIET CL7 PERMIT MANUAL.
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ISSUED BY"' DATE'INPE'CTED INSPECTED BY
6/6/2016 10:44 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: CONTRACTOR:_ ){
LOCATION: I
TYPE OF WORK: &'CIJ a'
DATE INSP NEEDED: DATE INSP: s 7
INSPECTED BY:�
WORK IN
PROGRESS:
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: _` DATE:
S/malloy/forms 2014 Town of South Windsor INPS£CTION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1 0 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00
Name of Firm Q� h1 r1 �� T�vc Phone No. S 2-3 Z-
Address of Firm of - 1� '� n/� ti Cam- Zip Coe
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Location of proposed work
Describe fully nature of permit requested e— ✓� R7`�P�J`�
Starting date \/ awe ? y t _Call Before You Dig No t33
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS, THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: CI No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut J4 Curb Cut ❑ Sidewalk Cut
Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out-by Town
two copies of separate drawing
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est.Patch Cost$
Est.Curb Replacement ft
Est. Curb Unit Price$ /ft
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$
DRIVEWAYS must be aft or more from the property line per Total Due$
section 2.17 of the zoning regulations
( }Cash O 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 TREET PERMI NUA .
Signed: Print Name 4�Ze-4-1 9 Date:
Street E"cation Permit 2014