HomeMy WebLinkAboutStreet Cut Permits 163 Birch Hill Drive (3) 1800003 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT PUBLIC UTILITY
DATE: 01/19/2018
GIS ID: 11400163 FEE: 50.00
MUNIS APPLICATION# 201800081 EXPIRATION DATE: O1/19/2019
APPLICANT LOCATION
NAME: CONNECTICUT WATER COMPANY ADDRESS: 163 BIRCH HILL DRIVE
ADDRESS: 25 NORTH ROAD OWNER: BACHAND MICHAEL R
EAST WINDSOR,CT 06088 163 BIRCH HILL DR
SOUTH WINDSOR,CT 06074
PHONE 860-623-3355
WORK DESCRIPTION: EXCAVATE TO REPAIR EMERGENCY WATER MAIN BREAK
CORREIA EXCAVATORS COMPLETED THE WORK
APPLICANT AGREES TO FURNISH 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 THE APPLICANT IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WIND R'Sf REE CUT PERMIT MANUAL.
�) b `ol (/(/
9
ISSUED BY DATE INSPECTED INSPECTED BY
1/19/2018 8:13 AM *** PERNIIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: O� CONTRACTOR:
LOCATION: IAA
TYPE OF WORK: (' ► yh,�r^� --ri'lo�i nab
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: C� wn�
4-a
f7 �0 syr� /i<uftfzt 5
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: i0
s/moiioy/forms 2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN IC WORKS DEPARTMENT Permit No.
TOWN HALL F15440 SULLIVAN AVENUE SOUTH WINDSOR SOUTH UTTH WINDSOR,CT 06074 FEE $25.00
Name of Firm CT WATER Comapny Phone No. 860-622-9562
Address of Firm P.O. Box 857 East Windsor (25 North Rd) Zip Code
Location of proposed work
Describe fully nature of permit requested Exc to repair emergency water main break. Correia Excavators
completed the work.
Starting date 1/8/2018 Call Before You Dig No 2nJ un1 n1 1 92
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN's CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut R Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
0 No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
See attached!! Est.Curb Cost$
Est. Sidewalk Replacement sf
Est.Sidewalk Unit Price$ /sf
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting the Police Dept.and C.B.Y.D Paid By
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH
ITH THIS PERMIT AND
THAT I AM FAR ANY EXPENSES INCURRED BY THE MILIAR WITH AND WILL ABIDE BY THE ORULES WN AND I REGULATIONS FOR PERMITS AS OUTLINED NTENANCE OR REPAIR WORK IN CONNECTION NVTHE OWN OF SOUTH
WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
Print Name G�� �� G��• Date:
Street Excavation Permit 2014
�}OK
a OBI
19
�G
99
99
t 4A
NA
V f.
As
Al
wit,
M3N�li
IN
A I
"XF
1�61
'ce
k.V
Eli
it'PN: _...I
41
\ ��4'.•' `.1 r��'�',�.`.MAR
wtti� ► �1-�ti`
�r dye _ -. � .1- � � � 'r:•.f tr�1A- f� '_.,,., ... r ��: .� ,
,S:f ,-' 'A H F J•'� M+_`,'w',.Tt'1f J i{ / � �RL° .. �'t[' �C
" j1w/ .YL1., �� � t L Y�' • •i � •%7C s,�j�; Y• �, ` fly,` _l :� �' G
of
t r a"��}SK"a .A�S ' '�.., �r� •`S�� r.}'YQ�.i�,' r��•{{.' ����r �tiY •�,, kF., -1 .H. •'y
of F.. y;Fi�l vP _.� .,'- ��'. }tl•���d ,�p:-r•, ��/;. P �11�a 'r►'!
Jt
lei
j )� <-tJ)fs 1tJ- �, i y�F T� .. ..rv.;Y • rr .t�•�rl
/t'4V S,� � a``�• y t r '4'�:.,` Y 1 }. �4 fl '�i��r 'A. J4� • � � ��i
• � P, S .�yy_y!, t ` Yet !�l .. • �'L � � �f
r Y• al Tr
�..• .. ./ - } • fir.r;j•. �� .b ti. �y - � y '+ ,
. Y
r
�� f RiC�T- a' �'A!•;i. � Gam' "'1i .� � .�
A
�s' rft �y
r i,
lir>
---------------------