HomeMy WebLinkAboutStreet Cut Permits 175 Diane Drive (3) 1600085 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/26/2016
GIS ID:28200175 FEE: 25.00
MUNIS APPLICATION# 201600679 114XPIRATION DATE: 05/26/2017
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APPLICANT T r` LOCATION
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NAME: QUALITY PAVING Q % ADDRESS 6' t,,
175 DIANE DRIVE
ADDRESS: 194 S.MAIN STRE1FIGUEYREDO JO-ANN M&EL1DI0 M
EAST WINDSOR, IANE DRIVE
h -OUTI�WINDSOR,CT 06074
�mwPHONE 860-523-4182 5 a
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WORK DESCRIPTION: DRf AM
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APPLICANT AGREES TO FURNISH THN�ZTOWN OF aOUTH ?VII�IDS43IZ FHE AMOU1 '40F BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A� XPENSES IN 1 ..UD IOW I FAR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TI3' LICANT IS FAMILIAR 4IT11 A1D WIT L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SQUTH Vi�INDSOR.',S STREET CUT HERMIT MANUAL.
ISSUED BY DATE I1V5PECTED INSPECT D BY
5/26/2016 9:46 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: /v/"0m CONTRACTOR: 4 1jaz/
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: 1 --
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES [] NO
AS-BUILT:
INPUT: DATE:
S/molfoy/forms 2014 Town of South Wndsor INPSEMON REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00
Name of Firm -j T Phone No. �r 3 , 2 -
Address of Firm Z10 Codee Z.02 19
Location of proposed work /7 �� g cVvo , 't_
Describe fully nature of permit requested e— CJc�., ,�,�.� � --j 0"-W4
Starting date L Call Before You Dig No
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: 12"o Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
I CF� Ir 0 Est. Patch Unit Price$ Isf
Est. Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est. Sidewalk Replacement sf
Est.Sidewalk Unit Price$ Isf
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ 1hr
Est.Traffic Control$
Amt.of Deposit$
DRIVEWAYS must be aft 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'S ST ET CUT KRMIT ANU L.
Sig Print Name � `��/ Date:
Street Excavation Permit 2014