HomeMy WebLinkAboutStreet Cut Permits 66 Farnham Road (2) 1900005 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 03/12/2019 h
GIS ID:32100066 FEE: 50.00
MUNIS APPLICATION# 201900394 r k k ? aEXPIRATION DATE: 03/11/2020
LOCATION
APPLICAI�TT��
NAME: CONNECTICUT W °TER C_OMPAIY Y as, �DDRiSS I6 FANHAM ROAD
ADDRESS: 25 NORTH ROAD G�'� s1 r+/ QR " 11ESCHENE JOYCE ANN
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EAST WINDSOR, �?"md"kallim
PHONE 860-623-3355 " QRK i rr{ y 3;
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WORK DESCRIPTION: EXAY'QEUrREA�IIZ I.Et�KIlC�1` A IERVCE WORKING FROM THE
CEI',>T��OE�Rft;I♦o cu�J B H s I3 A 1 I1 + E1 cY
APPLICANT AGREES TO FURNISH THTN OFlsO[JrT0:1 D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A1I' EA+iSES�N1URR$DY THE F�WF FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND T 3E t >I INNT TS FAMILIAR JIfiH A I), ILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN{9F
S01J H DSOR'` S ETFCUT,�"PERMIT MANUAL.
ISSUED BY DA`TPa ISPP CTED INSPECTED BY
3/12/2019 11:44 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** I
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TOWN OF SOUTH-.WINDSQR-INSPECUO" REPORT
PERMIT NO.: . DOD.�.S" CONTRACTOR: C GJ G
LOCATION: fo(�: I'a D
TYPE OF WORK: � �J � kA
DATE INSP NEEDED:
GATE INSP:
INSPECTED
WORKS IN
PROGRESS:,_ 4 ..
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K PUMPEQ 5MASHED; FILLED WIWNESSED ❑YES (] NO,
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AS-BUILT:
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S/moHo arms 2014 Taws of South WindsorINPSW=!FORT 14
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APPLICATION FOR STREET EXCAVATION PERMIT r
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00
Name of Firm CT WATER Comapny Phone No. 860-622-9562
Address of Firm P.O. Box 857 East Windsor 25 North Rd Zip Code
Location of proposed work RB Farnham Rd
Describe fully nature of permit requested Exc to repair leaking 1" water SVC. Working from the center
of road to curb. This is an emergency.
Starting date /6/2 19 Call Before You Dig No 20191000.907
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement, Curb or Sidewalk Cut 0 Pavement Cut ❑ Curb Cut 0 Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No. cuts
Est. Patch Size(s) sf
G t: 1.V- ,,l w,, Est. Pvt.Thickness in.
Est.Patch Unit Price
Est.Patch Cost$ i
Y Est.Curb Replacement ft
r
i r Est.Curb Unit Price
D Est.Curb Cost$
" A c Est. Sidewalk Replacement sf
Est.Sidewalk Unit Price$ /sf
Est.Sidewalk Cost$
Est.Traffic Hours hr
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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 Paid B
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES y
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 Date: 3 ZZ
Street Excavation Permit 2014