HomeMy WebLinkAboutStreet Cut Permits 9999 Kimberly Drive (4) 1700049 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 03/23/2017
GIS ID: 99995030 r' FEE: 0,00
MUNIS APPLICATION# 201700264r '
{ EXPIRATION DATE:
APPLICANTN�; F" l y {� � LOCATION
NAME: CONNECTICUT WATER CQMPAI' ADDRS ' ��99A IMBERLY DRIVE
ADDRESS: 25 NORTH ROAD IfiOWNi�F SOUTH WINDSOR PUBLIC
EAST WINDSOR,CT�6�08$ �4 `�17BGESS ROAD
PHONE 860-623-3355 ? t y QC TfI WINDSOR, CT 06074
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WORK DESCRIPTION: MO�E�#ky', T AI` G� NBRt> AC FS fI9 A E CORNER OF
KIMER ;Y�A
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APPLICANT AGREES TO FURNISH THIAU OWN'OF SOI`JT I4S PI DSO$`TI E 1�YVI(3 OFz B 3ND REQUIRED AND TO REIMBURSE
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THE TOWN OF SOUTH WINDSOR FOR 0YPENSESIREI��I3YtTHE T AINTENANCE OR REPAIR WORD IN
CONNECTION WITH THIS PERMIT AND TT A{PP�I IQANT I$ aMIXAR WII�H ANI WI ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF 3f3tITIT WIiII� pR'S STREET CUTxPIIvIIT MANUAL.
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ISSUED BY DATEPETED INSPECTED BY
3/23/20178:42AM ** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMrr NO:: ` L)LLJ cJ CONTRAMR C w C'_
LOCATION; r n
TYPE OF WORK: f
DATE INSP NEEDED: - DATE INSP:—
INS.P D
WORK IN
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SEPTIC TANK-PUMPED;SSMASH%FILLED WITNESSED ❑YES ❑NO
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INPUT: t�Nn' PATE:
S/mallay/than 2K4 Town of 5aulh Windsor mpswROWREP01M 14
APPLICATION FOR STREET EXCAVATION PERMIT
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- Appl.:.No TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWNHALL 1540 SULLIVAN AVENUE,. SOUTH WINDSOR,CT 06074 FEE $25.00
Name ofPrrt1 Phone No,•
Address of Eir
Location of proposed"'..' "
dascribe fully nature,of permit-ret�tttt#
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Starting date 3 ."l r 7 Call::Before.You Dig No
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PLEASE NOTE: THE.DEPOSIT FOR THE'PERMANENT..PAVEMENT:PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APP..LICANT.ISI RESPONSIBLE FOR TH£.FULL FINAL COST OF':THE PERMANENT PATCH AND CURS REPLACEMENT,INCLUDING ANY..
INCREASES IN PATCH AREA,CURB LENGTHi TRAFFIC CONTROL AND THE TOWMS:CONTRACT COSTS: THE PERMANENT PATCH IS .
TYPICALLY COMPLETED W...ITHIN O A YEAR F:THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A:YEAR
Check Applicable: O' No PaVement,.Curb or Sidewalk Cut I] Pavement Cut ❑ Curb Cut ❑. Sldewaik.Cut
❑ Existing Driveway,No Cti'anges ❑ Proposed Oriveway.Widening E2 Proposed-hew Driveway:
Water£'upply:. P.ubiic>Water ❑ Well Sewage::Service: Pub{icSewer ::ID Septic
3fiow sketch of proposed work or furnish: Indicate North This section to be llled out bv Town
two.coples.:ofseparate drawing
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Est. Patch Slze(s) of
Est.Pvt:Thickness._.. Mtn:
Est.,:Patch Ur`iit Price$ � ...... '
Est,Patch OustA.
f� Est.Ourb Replacement fit
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Est.Curb Unit Price 5 j
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Est,SidewalkAoe lacement sf I
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Est.Sidewalk Unit Price:$ /sf I
Est.Sidewalk Cdst;.$s
. Est.Traffic Houis:;;.,..::::,.:............
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EsTf c ...n. tCo st
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Este Traffic-Control;$ ..... .
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Amt:of.Depo$It$
7ottil Due� -
( )Cash ( )Check#, -
Applicant is responsrble Ior contacting the Police Dept.and..C.B.Y.D
PERMIT SHALL.BE KEPT ON JOBSITE AT ALL TIMES. Paid;By. :
1 AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO:REIMBURSE THE TOWN OPSOUTH
WINDSOR FOR ANY:EXPENSES INCURRED BY THE TOWN FOR lijI'INTENANGE OR REPAIR WORK W CONNECTION WITH THIS'PERMIT AND
THAT LAM F`AMILiAR WITH:AND WILL ABIDE BY THE RULES:ANI� REGULATIONS FOR.PEf MISS AS OQ TLtNED tN THE TOWN OF SOUTFI 3
WINDSOR'S STREET CUT PERMIT MANUAL.
Si ned :tee Print Name �,
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Street Excavation Permit 210.14
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