HomeMy WebLinkAboutStreet Cut Permits 100 Windsorville Road (2) 1-700010 T OWN O F-S-O U T H-W-N ITS 0 X,
PERMIT NUMBER STREET CUT PERMIT
DATE: 0I/31/2017
GIS ID:95700100 y FEE; 25,00
MUNIS APPLICATION# 201700086 VXPIRATION DATE: 01/31/2018
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APPLICANT 2 K41_ LOCATION
NAME: PELLETIER BUILDE#S ADbKES$ 10BWiDSORVILLE ROAD
ADDRESS: 138 MAIN STREET OW1VEIt HILDJEE GILBERT&JENNIFER
COVENTRY,CT 0625
�2 I�I`'CR TOWER RD
N rit S(UTI WINDSOR,CT 06074
PHONE 860-742-5317 F U
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WORK DESCRIPTION: WA�P, 'FAP AND ELECT RIB, 1 RVI �� F F 4
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APPLICANT AGREES TO FURNISH THE90) i QK.SOS T'PI VUII DS H AMC F3N1 Oli BL ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY t�PEh1SF$�NCURRED.$Y TiE TOWN I }12vIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE A-PPLIANT IS EAMII TAR WI Alp WdlL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN%OF SOUTH VJINI�SOIt',S;STREET CUT IRIVIIT MANUAL.
ISSUED B DA IIT PELTED INSPECTED BY
1/3I/201711:13AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: 0001 /� CONTRACTOR:
LOCATION: ZL2 LL' 444( �I)'JZ�
TYPE OF WORK:_
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS' c, c �,,� c� r i C4
SEPTIC TANK.PUMPED;'SMASHED,FILLED WITNESSED ❑YES ❑ NO
INPUT: DATE;
S/;nallay/fornts M14 Taws of South Windsor INPSWrt WIMPOU 14
1
AT'-KJCATION-FOR-STRE T EXCAVATION PERMIT
Appi. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00
Name of Firm (J Phone No. ;
1-5 s I - .
Address of Firm z� �°
Location of proposed work - Zip Cod
Describe fully nature of permit requested av,2 fifC` z �L-- F„/ J�
Starting date /
Call Before You Dig No-'
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA;CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: Q Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North7Thickness
be filled out-by Town
two copies of separate drawing 1mil sf
� � r ee,;dt 0 s In,
r Z ( 4 S Est. Patch Unit Price$ !sf
Est.Patch Cost$_
Est.Curb Replacement It
Est-Cl-,,b.Unit Price$ /f
Est.Curb Cost$
Est.Sidewalk Replacement sf
Est.Sidewalk Unit Price$ /$f
Est.Sidewalk Cost$�
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
Applicant is responsible for contacting the Police Dept.and C.B.Y.D ( )Cash ( )Check#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Paid By
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 AEP BY THE PU `T'Pj, RIEGUL ATIONS FOR PERMITS AS OUTLINED IN THE Tf- N OF SOUT"
WINDSOR'S STREET;CUT ERMIT MANUAL. ;
Signed: ✓/r ' �vZ1 _ Print Name G�/�`lv) l-1 a! �Li-l
-- Date:
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