HomeMy WebLinkAboutStreet Cut Permits 51 Glendale Road (4) 1600145 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 07/19/2016
GIS ID:35400051 FEE: 25.00
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MUNIS APPLICATION# 201601005 t _ 5 EXPIRATION DATE: 07/19/2017
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APPLICANTLOCATION
NAME: 51 GLENDALE LLC ADDRESS S1 GLNDALE ROAD
ADDRESS: 51 GLENDALE Rol bo"' z11�IELL N RICHARD B&I{ELLY J
SOUTH WINDSOR,LTQ6474 619
�SOUTZI WINDSOR,CT 06074
PHONE u'
WORK DESCRIPTION: EXtyATEW ER AY2EA FQR D 'TIONAL DRILLING UNDER
RO FOR IE W � 8 SERvCE �` �:' try
APPLICANT AGREES TO FURNISH THi;TOWI QF CITH; I DSG)Rt2HE AMSJI;N OF B'bND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A l ix XP1;i FSFS I ICURR Ty BIB T11E jAlw$ �i I d41AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND LES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN` F 80ZjTH VINI�S()R' STRElJ "T' RMIT MANUAL.
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ISSUED BY DATE PELTED INSPECTED BY
7/19/20I612:06PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: L /
INSPECTED BY: '�
WORK IN
PROGRESS: r:,,cr/ A4c
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SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: lw DATE:
S/molioy/forms 2014 Town of South Windsor INPSELMON REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
4 r TOWN HALL 1640 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00
Name of Firm J4 Z C Phone No. 2Go
Address of Firm o. 60� �Asfi w ` �snv ��� II . c t-- Zip Code O Cad-�
Location of proposed work ( G(s� L f-J DSO
Describe fully Mature of permit equested ?Cc,d��.+4� �'C P r tea - �'
-
Starting date - 2 `� / Call Before You Dig No ca L C" Z C)
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway; No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out-by Town
two copies of separate drawing
sNo.cuts
),2/,j c .A ! Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
E
4 Est.Curb Replacement ft
i Est.Curb Unit Price$ /fit
W U' V2- Est.Curb Cost$
/( Est. Sidewalk Replacement sf
I Est. Sidewalk Unit Price$ /sf
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
�o ,Are= n�Wk N Fpv z A
Amt.of Deposit$
DRIVEWAYS must be 3ft 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 FUR ISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH
WINDSOR FOR A EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND
THAT I AM FAMILI R WITH ND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDSOR'S ST CUT P MIT MANUAL.
Signed: :ZN LVPrint Name CY}CQ �J __ Date:
Street Excavation Permit 2014
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