HomeMy WebLinkAboutStreet Cut Permits 168 Edgewood Drive (2) 1600108 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STIZEEILCU-T-RE--1 M-T
DATE: 06/20/2016 4
GIS ID:29400168 mol� t FEE: 25.00
MUNIS APPLICATION 4 201600826 h 5 Y 'IrXPIRATION DATE: 06/20/2017
APPLICANPI ;fty ks LOCATION
NAME: CENTRAL SEALINGCO INC ADDRESS 168-EDGEWOOD DRIVE
ADDRESS: 150 SUNSET RIDGE DRIVE OWNER APENTA 13ARBARA
EAST HARTFORD,C�� 16"Q8 ,. -` ~, I56$ EDGEWOOD DRIVE
� r tiE SOUTp,.-WINDSOR,CT 06074
PHONE "
WORK DESCRIPTION: DR�V
APPLICANT AGREES TO FURNISH I TOW' 61,�OUT���Ip,��}��I�E A�VL��IIJT QF FOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A+ISJ£PNSU -U D THY'THE TO Tl�ORYIVIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TI �LCANT IS 1~AMTLIAR GVITH{A7�[D W1 L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWMOF Sf)U'TH WINDS.O 'S STRE F CUT PERMIT MANUAL.
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ISSUED BY DAT&NffECTED INSPECTED BY
6/20/2016 2:19 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: / i�) CONTRACTOR:
LOCATION: f(o 'Edo p 6S2 004 D,�
TYPE OF WORK: 1 P
DATE INSP NEEDED: DATE INSP: 119117
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: ,ice DATE: '
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT` �
Appl. No. TOWN OF SOUTIHLWI VDSOR P_USLIC-WORKS-DIERARTMZ!71 Permit-No.
TOWN WALL 1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074 FEE $25.00
( klh-+ SeAl I
Name of Firm 00 1 A G Phone No.
Address of Firm 1 S L,v1 sc f K:Lz ye- G C q- C Zip Code 0 11
Location of proposed work tobgO Tyn ve
Describe fully nature of permit requested i(-et)' CY-e/ ri r Tp t a ce TQ y¢"i
Starting date Call Before You Dig No "I-0
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PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WfTHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed NewjDriveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ ESeptic
i
Show sketch of proposed work or furnish Indicate North This section to be�filled out bvTown
two copies of separate drawing
No.cuts
0 Est. Patch Size(s) I sf
l� f` Est.Pvt.Thickness ! in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$ I
E
Est.Curb Replacement ft
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Est.Curb Unit Price$ Aft
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Est.Curb Cost$
Est.Sidewalk Replacement sf
Est.Sidewalk Unit Pnce$ Isf
4(' �� t Est.Sidewalk Cost$
rl Est.Traffic Hours hr
h —. __.__---•--•--.._.--.-,... Est.Traffic Unit Cost !hr
�Ir�v r Est.Traffic Control
Amt.of Deposit$
Total Due$ I
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Applicant is responsible for contacting the Police Dept.and C.B.Y.D }Cash Chec
PERMIT SHALL BE KEPT ON dOBSITE 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 ST EET CUT#ERMIT MANUAL. I
Signed: Print Name �,TLt !e,7-erl i ZZ, Date: � � i
Street Excava; ermit 2014