HomeMy WebLinkAboutStreet Cut Permits 9999 Graham Road (5) 1700196 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/08/2017
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GIS ID:37509999 }\` FEE: 50.00
Ad`MUNIS APPLICATION# 201701213 y y <, `EXPIRATION DATE: 09/08/2018
LOCATION
APPLICANT
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NAME: SIMSCROFT ECHO RMSL` ADDRESSGRAHs^M ROAD
ADDRESS: P O BOX 581 ; yr j OWNER OWN{JF SOUTH WINDSOR
SIMSBURY,CT 06QOiF 15411'SUI,LIVAN AVE
t: 4zw, �' SOUTH, INDSOR,CT 06074
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PHONE 860-651-0231 w
WORK DESCRIPTION: ST�W� E�RORARI�IILI�sIkA� IIIE STATES AT
SO, HIM— I30�I,IERS
APPLICANT AGREES TO FURNISH THis O OFOiH WI11�D�SRHE?NIQUI�IIQI BAND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AYPISE,S INCLIRI�ED_I3 Y tHE Tb F�Rr1VIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND T A��LI_C`,ANT 113 I ILIAR WITH 4} 11 L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SbiII I PERMIT MANUAL.
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ISSUED BY DAT INSPECTED INSPECTED BY
918/2017 H-.08 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.. 1700�;f CONTRACTOR: 'r
LOCATION: 9 g g '
TYPE F WORK: � * ' 'Sc�
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DATE INSP NEEDED: DATE INSP: IL1711g
INSPECTED BY: j3 b
WORK IN
PROGRESS: R � - - "G �
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES [-] NO
AS-BUILT:
INPUT: Gam' DATE:
S/moiloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl, No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074 FEE $50.00
Name of Firm Q� 174 Phone No. (r��c) t - y,Z 3
Address of Firm GiJ Zip Code c;c `To
Location of proposed work' . +--r=hU-
Describe fully nature of permit requested
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Starting date Calf Before You Dig No-20/ 1 3 Z<) 1i ,Z 12-
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY
INCREASES-IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'$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: [I No Pavement,Curb or Sidewalk Cut L3 Pavement Cut 13 Curb Cut ❑Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening 21 roposed 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
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Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
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Est. Curb Unit Price$ Ift
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 3ft or more from the property line per Total Due$
section 2.17 of the zoning regulations
( )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'$8T T T PERMIT MAN L. '
Signed: ti�ti� Print Name �P I Y�� Date: > -
Engineerin /permits/Street Excavation Permit 2017
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