HomeMy WebLinkAboutStreet Cut Permits 9999 Clark Street (12) 1600153 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/11/2016
GIS ID:20409999 FEE: 25.00
MUNIS APPLICATION# 201601105 EXPIRATION DATE: 08/11/2017
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APPLICANT LOCATION
NAME: SIMSCROFT ECHO FARMS ' AbI1tLS CLR STREET
ADDRESS: P O BOX.581 OWNTR"u , SOUTIIWINDSOR TOWN OF
SIMSBURY,CT 0601�/0 t J 5403LiI LIVAN AVE
s ` S9UTH WWINDSOR,CT 06074
PHONE 860-651-0231 ry S k
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WORK DESCRIPTION: CUB zU7UTH I;NIRANCE GHAi?;QNI,S WAY AND CLARK STREET
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APPLICANT AGREES TO FURNISH TH);aXOWN OF OUTH WI TDSf RiI IE AM( CJIJMF B&D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR....Al Y KPEIaT3E5 IP GI)RRED_13' TF1E TaWI wFO1�MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TfE A PPS ICANT IS 1'AiUTIIAR Wj'IH AND�V� L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO WNY S(IUTH iIJINpSQR'S STREET CUB PE IIT MANUAL.
ISSUED B DATE INSPECTED TNSPECTED BY
8111/20161:05PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES"*
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: oC} 1, �', CONTRACTOR:_ I 5
LOCATION: ---
TYPE OF WORK:__-C jg'\-o Cu.-k- SD: f',pmc�A- +(1c e
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: !3p
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/mol[oy/forms 2014 Town of South r+iindsor 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 $25.00
Name of Firm '•rn- c � - fr�1�. j-a ,,n s 1 Phone No.t lGci) 04.3 1
Address of FirmZ '757, +r-t �i Zip Code LLo,o`-ta
Location of proposed work C =:
Describe fully nature of permit requested (�-,j r t-IS ��� Gr,�e�x �_• - + ¢
Starting date ,t'►j q a--A . Ze1L.e _ _ Call Before You Dig No ' ._
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE L�AT/E THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut I Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway,No Changes. ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: WPublic Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
Est. Patch Size(s) sf
�2F � � (�� Est. Pvt.Thickness in.
i Est.Patch Unit Price
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Sidewalk Replacement sf
Est.Sidewalk Unit Price
Est.Sidewalk Cost$
Est.Traffic Hours hr
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
( )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
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 T TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND
THAT 1 AM FAMILIAR WITH AND WILL ABIDE B THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDSOR'S STREET CUT P MI�MAN AL.
Signe : Print Nam , YJi kLjJC-k-7t_ Date ,�� 1t�
Str t Excavation Permit 14