HomeMy WebLinkAboutStreet Cut Permits 155 Valley View Drive 19000.06 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 03/12/2019 z 4ri
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GIS ID:91200155 FEE: 50.00
MUNIS APPLICATION# 201900395
zLXPIRATION DATE: 03/11/2020
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APPLICANTw f T LOCATION
NAME: CONNECTICUT W Er � i
ILLEY VIEW DRIVE
ADDRESS: 25 NORTH ROAD l N
F 4 ,_ CW1R f tiL +COSJVTN GERALD A&SHIRLEY M
Vt�LLEY VIEW DRIVE
EAST WINDSOR,
PHONE 860-623-3355
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WORK DESCRIPTION: EX'I(, AV�1 B� ( REPAID&"19I YN�Bk)✓ATC 4RI fiCr IN THE ROAD
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APPLICANT AGREES TO FURNISH THIa�TO QFrSOLIT }fi7INIt1 �JiE AQ(7N C}F BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AvI AXPEN.'wo"Ul,I.JRR D$Yk YT TOWIJ Fp�t MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TIAAPP,LIzCA1T T3 FVIFLIAR GITH A' iD?ALL ASIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOW"101 SC7i1`I H WIIVDSOR?"S S"I RE T`CUfi EI RMIT MANUAL.
ISSUED BY DATE' PECTED INSPECTED BY
3/12/2019 11:51 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH•1NINDSORINSPECUDW REPORT
PERMIT NO.; CONTRACTOR: cj
LOCATION 'S I i r vt-�►
TYPE OF WQRK. i r Aln 6&,aL
DATE IMP NE Mid DATE INSP;.
INSPECTED BY., 3�
WORK:IN
PROGRESS.
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SEMC TANK PUMPOr:SMASHE. FILLEt) 1NITNESSED ❑YES NO
AS-BUILT';,
INPUT: DATE:_._.
S/mellay/form 2M4 Taws of south Windsor•INP WMN it'EFaRT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No. i
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00
Name of Firm CT WATER Comapny Phone No. 860-622-9562
Address of Firm P.O. Box 857 East Windsor (25 North Rd) Zip Code
Location of proposed work 1.55 Valley View fir j
Describe fully nature of permit requested Exc to repair 8" main break. Working in the road.
Starting date 3/11/2019 Cali Before You Dig No 201911002.93
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
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Check Applicable: ❑ No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway j
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
0 No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in. j
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Est. Patch Unit Price$ /sf
f _ j Est.Patch Cost$ l
V, 7 r/res Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est. Sidewalk Replacement sf
Est. Sidewalk Unit Price$ /sf
ff/0
j` Est.Sidewalk Cost$
Est.Traffic Flours hr
/ Est.Traffic Unit Cost$ /hr
/ Est.Traffic Control$
Amt.of Deposit$
Total Due$
( ) Cash O Check#a!
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 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 STREET CUT PERMIT MANUAL.
Signed: Print Name G AV2;,W t1 Date: 3 /
Street Excavation Permit 2014
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