HomeMy WebLinkAboutStreet Cut Permits 168 Edgewood Drive (3) 1600108 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STIZEEILCU-T-RE--1 M-T
DATE: 06/20/2016 4,
GIS ID:29400168 FEE: 25.00
MUNIS APPLICATION 4 201600826 ;6 5 Y % 'EXPIRATION DATE: 06/20/2017
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APPLICANPls
I y 4 LOCATION
NAME: CENTRAL SEALING CO INC ADDRESS M-EDGEWOOD DRIVE
ADDRESS: 150 SUNSET RIDGE D1 VE OWNER IAPENTA BARBARA
EAST HARTFORD,A. '16 Q$ .x. -`fi `; Ib �EDGEWOOD DRIVE
� r tiE SOUTWINDSOR,CT 06074
PHONE "
WORK DESCRIPTION: DR�V WAS
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APPLICANT AGREES TO FURNISH THIt CIMM flO1 E AM�I IIJT QF FOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A+Iftm'bNNE E IOURRED THY THE TO IlFxORY1VIAINTENANCE OR REPAIR WORK 1N
CONNECTION WITH THIS PERMIT AND TI �LICANT IS 1~AMILIAR VItITH{A7�[D W1 L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED INJ{'JTHE TOWN°OF SOUTH WINDSA°S STRE F CUT PI RMIT MANUAL.
ISSUED BY DAT&WSPECTED INSPECTED BY
6/20/2016 2:19 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:; 16001e9A CONTRACTOR:
LOCATION:
TYPE OF WORK: 1
DATE INSP NEEDED: DATE INSP: 119117
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT:_ _ r DATE: '
S/molloy/forms 2014 Town of South Windsor INPSECIION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT` �
Appl. No. TOWN OF SO -THI-WINDSOR P_USLIC-WORKS-DIERARTMZ!7T Permit-No.
TOWN WALL 1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074 FEE $25.00
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Name of Firm 00 1 A G Phone No.
Address of Firm 1 5 L,v1 sc f K:Lz ye- , C• Zip Code 11
Location of proposed work Uky QQ0i Tyn ve
Describe fully nature of permit requested i(-etYICY-eer p to ce C 1'1 ye w
Starting date Call Before You Dig No ")-o f,�I(p
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PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WfTHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut 0 Curb Cut ❑ Sidewalk Cut
Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed NewjDriveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ ESeptic
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Show sketch of proposed work or furnish Indicate North This section t be�tilled out b Town
two copies of separate drawing
No.cuts
0 Est. Patch Size(s) 1 sf
l� f` Est.Pvt.Thickness ! in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$ I
E
Est.Curb Replacement ft
Est.Curb Unit Price '
$ fft
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Est.Curb Cost$
Est.Sidewalk Replacement sf
Est.Sidewalk Unit Pnce$ Isf
Est.Sidewalk Cost$
rl Est.Traffic Hours hr
. .----_-.__.__---•--•--.._.--.-,... Est.Traffic Unit Cost 1$ !hr
Est.Traffic Control
Amt.of Deposit$
Total Due$ I
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Applicant is responsible for contacting the Police Dept.and C.B.Y.D }Cash Chec
PERMIT SHALL BE KEPT ON dOBSITE AT ALL TIMES Paid By
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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 EET CUT#ERMIT MANUAL. I
Signed: Print Name Olt e,7-er(I ZZ, Date: � � i
Street Excava; ermit 2014