HomeMy WebLinkAboutStreet Cut Permits 160 Benedict Drive (2) 1700197 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/14/2017
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GIS ID: 096001604r FEE: 50.00
MUNIS APPLICATION# 201701232 s `EXPIRATION DATE: 09/14/2018
APPLICANT' ' r 4 't { LOCATION
NAME: QUALITYPAVING C ADDRPJS1Gb`BHNEDICT DRIVE
ADDRESS: 194 S. MAIN STREET ' s s ODUN1aR TA.COG T JOHN ROBERT
EAST WINDSOR,Ct8 " 1�i�BNEDICT DRIVE
14
VVINDSOR,CT 06074
PHONE 860-523-4182 j
WORK DESCRIPTION: DRlfty� of TNl
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APPLICANT AGREES TO FURNISH THT O SOLI 1L WTNDSOiE AMOCT�QF BLOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR Ali Y E &vIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND T AP LICAJT,IS PAlV1TI IKAIZ WITH AhFD WL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO WN(3R SOUS HV�IDSOIZ S STREEI CUT P, f1NIIT MANUAL.
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ISSUED BY OATE 1NPECTED INSPECTED BY
9/14/20171I:28AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT -
PERMIT NO.: i 7 A9 19 7 CONTRACTOR: az Af y),0
LOCATION: 16,tg
TYPE OF WORK:- ,i t .00�j - - -.
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: �
WORK IN
PROGRESS: --
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT: "
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSECfION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN WALL 7 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074 FEE $50.00
Name of Firm ..er °�� Phone No. - �" ��
Address of Firm Z2v 0� cy`f Zip Code ��d 0,,9
Location of proposed work ZO /, fsc�r Ct
Describe fully nature of permit requested >
Starting date Call Before You Dig No
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE:
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑Curb Cut ❑Sidewalk Cut
Xfrting Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch.of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
L
Eat.Curb Replacement ft
Est.Curb Unit Price$ /ft Est.Curb Cost$
(no, Est.Sidewalk Replacement sf
Est.Sidewalk Unit Price
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
DRIVEWAYS must be aft or more from the property line per Amt.of Deposit$
section 2.17 of the zoning regulations
Total Due$
Applicant is responsible for contacting the Police Dept.and C.B.Y.D
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES ( )Cash ( )Check#
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 AN REGULATIONS FO ERMITS AS TUNED IN THE TOWN OF SOUTH fWINDSOR'S STREET C T PERMIT MANUAL.
Sig ed Print Name G� /i G� Date:
Engineering/ ermits/Street Excavation Perm 2017