HomeMy WebLinkAboutStreet Cut Permits 73 Orchard Hill Drive (2) 1800007 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 02/15/2018
GIS ID:66900073 FEE: 50.00
MUNIS APPLICATION# 201800189 5; EXPIRATION DATE:
APPLICANT LOCATION
NAME: CONNECTICUT WATER IXO'1VIPA ARD HILL DRIVE
ADDRESS: 25 NORTH ROAD y dWNER �✓ARR RAYMOND M&KIM L
EAST WINDSOR,CT 6k88 ti 93 OIC)1ARD HILL DRI
f SOUGH �VINDSOR,CT06074
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PHONE 860-623-3355 ti
WORK DESCRIPTION: EX6� TE TO REPAIR I;4M RGE�iGY WAT R11t1AINBREAK 2 OPEN CUTS
WEI IO1E ID i�IIS REPAIR BOTH ON ORCHiAIt HILL DR
APPLICANT AGREES TO FURNISH TH�"'OWN OF SOUTH VINDSQX. IM AMOUI T101?BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AlV Y LXPENES INCUIIRED B THF�TOWN FOR.IVIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND Th WLJCI ANTIS FAIUIII IAR V ITH AD WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH W114DISOWS STR"' ITMANUAL.
ISSUED B DATE IISPECTED INSPECTED BY
2/15/2018 9:14 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: - CONTRACTOR:
LOCATION: G r I
TYPE OF WORK: n
DATE INSP NEEDED: DATE INSP: r /
INSPECTED BY:
WORK IN
PROGRESS: �'�✓d ;,� .-� rr�• H' I r
iG7 L1'CGL�, af�l, Z 4t Cw�li /�le•c.� � t'c;�
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT: '
INPUT: (', . DATE:
S/molloy/forms 2014 Town of South Windsor INPSEMON 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 $25.00
Name of Firm CT WATER Comapny Phone No. 860-622-9562
Address of Firm P.O. Box 857 East Windsor (25 North Rd) Zip Code
Location of proposed work
Describe fully nature of permit requested Exc to repair emergency water main break. 2 open cuts was
done for this repair. Both were located on Orchard Hill Dr.
Starting date 1/29/2018 2/1/2018 Call Before You Dig No 20180402346
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
0 No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
Est.Curb Replacement ft
See attached!+ Est. Curb Unit Price$ /ft
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$
Total Due$
( )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's STREET CUT PERMIT MANUAL.
Signed: Print Name e/.` +--ns2e .— r"— Date:
Street Excavation Permit 2014
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