HomeMy WebLinkAboutStreet Cut Permits 9999 Kimberly Drive (2) 1700049 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
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DATE: 03/23/2017 w t K s
GIS ID: 99995030 r FEE: 0.00
MUNIS APPLICATION# 201700264r S
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{ EXPIRATION DATE:
APPLICANTN�'F" l y �` LOCATION
NAME: CONNECTICUT WATER COMPAI' ADDR) S �� 49A IMBERLY DRIVE
ADDRESS: 25 NORTH ROAD sk ,(AVER ' TpWNOF SOUTH WINDSOR PUBLIC
EAST WINDSOR,CT, 06I18$ 17BGESS ROAD
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PHONE 860-623-3355 ? t yQC)TI WINDSOR, CT 06074
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WORK DESCRIPTION: MO`� ElliQYQG� N1;1?,tACF ;I9AE CORNER OF
KIMEIiY�AAN�IRA
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APPLICANT AGREES TO FURNISH TH&OWN OF SO JT kH VS71I'1D5()R`TI E 1 VIO OFz B 3ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ATtY-p,7 PENSES ;I I RI I �T3 tTHE TQW1+T �1 AINTENANCE OR REPAIR WORD IN
CONNECTION WITH THIS PERMIT AND TT A{PIIIQANT I$��MI�XAR WII�H A]!JI�W 1 ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS ASOUTLINEDrll THE TOWN� 'SbFtITIT WII I� dl 's STRir f Ci1TXP 1IMIT MANUAL.
ISSUED BY DATEPECTED INSPECTED BY
3/23/20178:42AM ** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: ` L)LLj- 9 CONTRACTOR , C w C'_
LOCATION; r n
TYPE OF WORK. A. R
DATE INSP NEEDED: - DATE INSP:—
WORK IN
PROGRESS' •-- r;, f
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SEPTIC TANK.PUMPED;SMASH9Dr FILLED WMMED ❑YES ❑NO
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INPUT: t�Nn PATE:
S/moltoy/forms 2M4 Town of Saulh Windsor INPSWRON'WORT 14
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TdWN,HALL 1540 SULLIVAN AVENUE,. SO4T WINDSOR,CT 06074 FEE $25.0..0
Name of P6 Phone No,• - L 2
Address of I It ,�� �p.,Code
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Location of proposed war J.A-
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�c describefuliy nature of permlt;rt3l�tt� t#� �^ �-: •. .
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Starting date 3 ."l r 7 Cali Before You Oka -.—. .
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PLEASE NOTE' THE:.DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND:CURB REPLACEMENT IS A PRELIMINARY.ESTIMATE THE
APPLICANT IS RESPONSIBLE FOR THE.FULL FINAUCOST OF:THE PERMANENT PATCH AND CURS REPLACEMENT,INCLUDING ANY..
INCREASES IN PATCH AREA,CURS LENGTH TRAFFIC CONTROL AND THE TOWNS:CONTRACT COSTS: THE PERMANENT PATCH IS .
TYPICALLY COMPLETED W...ITHIN A YEAR OF:THE TEMPORARY PATCH BUT Lp.IT COU BE LATER THAN A YEAR:
Check Appiicable:' ❑' No PaVement;.Curb or Sidewalk Cut ❑ Pavement.Cut ❑ Cur4Cut ❑ Sidewaik.Cut
.:❑ Existing Drivoway,3Vo Cti'anges ❑ Proposed.Oriveway.Widening El Proposed New Driveway:
Water 5'lpply:; Public Water ❑ Well Sewage Service: PUfa{icSetiver ::D Septic
Showsketch of.proposed work or furnish Indicate North This section to be III6d out bv Town
two.coplQs of separate drawing
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Est. Patch Slze(s) sf
Est.Pv1:Thickness;;
Est..:Patch Uriit Price$� ..�t8t
Est,:P:.c
11 Est.Curb Replacement fit
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g Est.Curb Unit
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Est.:.Curbaiset . .
- � Est;Sidewplk Replacement�_sf` i
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Est.Sidewalk Unit Price. �sE•
ist.Sidewalk Cost;.$: .... ..._._.__....
Est.Traffic Hours:;:..: ..:............:..:............:.::::..::.....;,hr
EsV71! fic Unit Cost [
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Este Tratfic C ntros) , ,.�.: .
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Amt:of.Depo$It S
Total Due k .
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( )Cash ( )Check
Applicant is responsible for coniacthg the Police Dept.and..C.B.Y.D
PERMIT SHALL SE KEPT:ON J.OBSITE AT ALL TIMES. Paid:By
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I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOF THE AMOUNT OF BOND REQUIRED AND TO:.RC-IMBURSE THE TOWN OF SOUTH
WINDSOR FOR ANY:I:XPENSES INCURRED BY THE TOWN FO�i MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND
THAT LAM:.FAMILIAR WITH;AND WILL ABIDE BY THE.RIfELS:AND REGULATIONS FOR.PEMMITS AS 0 TUNE iN THE TOWN OF SOUTH
WINDSOR'S STREET CUT.PERMIT MANUAL.
Signed; Print Name
Street Excava#i ow,Permit 2014
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