HomeMy WebLinkAboutStreet Cut Permits 9999 West Road (4) 1700218 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 10/I6/2017 _
GIS ID:93609999
MUNIS APPLICATION# 201701444 FEE: 0.00
EXPIRATION DATE: 10/16/2018
1
APPLICAMT 1
NAME: SERTEX _;}l . LOCATION
ADDRESS: 22 CENTER PARKWAY _ ADDRESS . UNDEFINED
PLAINFIELD, CT 0634ER SOUTH.WINDSOR TOWN OF
3 y 1540-SULLIVAN AVE
PHONE 401-454-4102 X 102t2 k
SOUTH WINDSOR CT 06074
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WORK DESCRIPTION: DI GWG OIn$QTH II3ES Ok ROAp TOR YNNERDUCT UNDER
ROA}D91I� T ROAD TO$URGIaSS�fa�VAT pIZQECT NO FEE
APPLICANT AGREES TO FURNISH TH
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E'TOI bF gOUT1xTI1�1DS{}1Z THE AMQ171�I IO BOND REQUIREb AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN,Y EXPENSES ITCUKRED 13Y THE TOWNFR:IvIAII`1TENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TIE APRLICANT,.IS FAMILIAR WITH AtrID VYII L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN f,F 9d"UTH WINDSOk. STREET CUT PER MANUAL.
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ISSUED BY ATE INSPECTED INSPECTED BY
10/16/2017 10:12 AM PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: g_
LOCATION: jjo,c,
TYPE OF WORK: V ` r
DATE INSP NEEDED: DATE INSP;
INSPECTED BY: `t l�
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT: '
INPUT: C DATE: " a3 t
S/molloy/forms 2014 Town of South Windsor INPSEMION REPORT 14
AFFLIGA I IUN I-UK 5 I Ktt I LAGAVA I IUN rr-KM1 I
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074 FEE $50.00
Name of Firm Phone No.
Address of Firm 2 L cams „.,�'h w � !c-id L-F A&4dMWZip Code ed 3 75'_
Location of proposed works �- �? d 'q q t
Describe fully nature of permit requested r � k
Starting date_ t B/r G /i 7 Call Before You Dig No
PLEASE:NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑Curb Cut ❑Sidewalk Cut
❑ Existing Driveway,No Changes O Proposed Driveway Widening ❑Proposed New Driveway
Water Supply: ❑Public Water ❑Well Sewage Service: ❑ Public Sewer ❑Septic
Show sketch.of proposed work or furnish Indicate North This sec ion to be filled out by Town
two copies of separate drawing
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
r Est.Patch Unit Price
f 5L) Est.Patch Cost$
�' Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Sidewalk Replacement sf
( v�aQUo-� Est.Sidewalk Unit Price$ /sf
-o^ ' �-°ss Est.Sidewalk Cost$
/V -V
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
DRIVEWAYS must be 3ft 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 JOSSITE 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 AND REGULATIONS FOR PERM S S OUTLINED IN THE TOWN OF SOUTH W�INDSOR'S STREET CUT PERMIT MANUAL.
Signed: 2'' Print.Name l>C �_ 2��� S Date: fO�I //
Engin ring/permits/Street Excavation Permit 2017