HomeMy WebLinkAboutStreet Cut Permits 9999 Simcka Drive (2) 1900041
PERMI'g NUMBER TOWN OF SOUTH W I N D S O R, CT
.r STREET CUT PUBLIC UTILITY
DATE: 05/03/2019
GIS ID: 82909999
MUNIS APPLICATION# 201900830 FEE:
�>rXPIRATIONDATE: 50.00
' 05/02/2020
APPLICAN4`T t}
NAME: � ,`
EVERSOURCE �Y LOCATION
ADDRESS: 112 PROSPECT HIL1,ROAD ADDRESS SIIVICA DRIVE
_, OTTER I�WN�OF SOUTH WINDSOR
EAST WINDSOR, tTtpp$gSLLIVANAVE
PHONE
WORK DESCRIPTION: EXCAVA _ �r
� ti,T,E TO INSTA:LT.GA'S NY'A,XN A1V���R'VfGE 1
APPLICANT AGREES TO FURNISH T
THE TOWN OF SOUTH WINDSOR FOR fiNY1✓Rl'ENS %AM031T�F FOND REQUIRED AND TO REIMBURSE
H WI�iDSO1i T
CONNECTION WITH THIS PERMIT AND TIC tPPLICANT ISUFADHOV4 [kTsO IN
FOR PERMITS AS OUTLINED IN THE TOWN'O MAINTENANCE OR REPAIR WORg
AA WELL ABIDE By THE RULES AND REGULATIONS
k SOUTH WIIVDSOR,S STItEETCC7TPERMITMANUAL.
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ISSUED BY '
DA T-INSPECTED
5/3I201910:40AM INSPECTED BY
*** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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Town OF SOUTH.WINQSOR INSPWUON REPORT
PERMIT NO.: CONTRACTOR. 4
LOCATION:
TYPE OF WORK: j2
DATE INSP NEE#IED:.= _ .
DA1E INS
INSPECTED BY: .?
WORK-,IN ris e
PROGRESS: ��� �� • .i= �„ �s � r�-,.,..�- -
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SHED FILLED wrmESSED Ei-YES ONO,
SEPTIC TANK PUMPED,SMA. r
AS-BUILT;� .
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INPUT: �!''� DATE:
5/inoitoy/fot s 2014 TOMS flf sough Windsor INPSf L'TiON Ri~PORI'14
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Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074 nFEE $50.00
Name of Firm -1-7n Phone No. (� "fc _
Address of Firm 0 Zip Code
Location of proposed work .
Describe fully nature_of permit requested 0-avEffpDn IN.Ska, a4s mwej X✓'G,
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Starting date Call Before You Dig No cQojf-1 4 ^,5/66
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PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT.,INCLUDING ANY
INCREASES.IN.PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS_ THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR,
Check Applicable: El No Pavement,Curb or Sidewalk Cut j4.Pavement Cut ❑Curb Out ❑Sidewalk Cut
I
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑Well Sewage Service: ❑ Public Sewer ❑Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
Est. Patch Size(s) sf
Est.Pvt.Thickness in.
1)CQ N 5 Est.Patch Unit Price$ /sf
Est. Patch Cost$
Est.Curb Replacement ft i
. i
Est.Curb Unit Price$ A
Est.Curb Cost$
Est.Sidewalk Replacement sf
Est.Sidewalk Unit Price
Est.Sidewalk Cost$
t
Est.Traffic Hours hr f
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
O Cash O 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
WWDSOR' ST �PERMIT ANUAL.Signed: PrintNamee_e'/&,, e�^t r-/VriJ:e4 Date: �d r
Englneering/p rmits/Street Excavation rerm1L Gux.