HomeMy WebLinkAboutStreet Cut Permits 174 Farnham Road 1700202 TOWN OF SOUTH WINDSOR, CT
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DATE: 09/14/2017
GIS ID: 32100174 FEE: 50.00
MUNIS APPLICATION# 201701238 ,;1 F�XPIRATION DATE:
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PPLICANT
NAME: CONNECTICUT WAFER COmPANG'' ADDRESS „ 17FANHAM ROAD
ADDRESS: 25 NORTH ROAD h5 .4 ; OWNER 73E�TGT50N THOMAS G
EAST WINDSOR,Cg'0� 8 ' 174 P 1§§4HAM ROAD
4� SQUI'H WINDSOR,CT 06074
PHONE 860-623-3355 5
WORK DESCRIPTION: REIEYIAT$RER�VTCE AGROSS TOTE IOAI� �` r
APPLICANT AGREES TO FURNISH THI sTOVd }F SOUTH WINDSQR T IE AMOLXNPREQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FORA SES,INCIRI�EI53 ATE T�J�VI PpI <MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APp;ICANT`IS 1'7#MTI IAR WITH ADD V X 1 ABIDE BY THE RULES AND REGULATIONS
FORPERMITS AS OUTLINED IN THE TOWN l7F SOUTH WI7VDSOII';S ST1 ET GU I PERMIT MANUAL.
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ISSUED BY DATE'fI S:PWTED INSPECTED BY
9/14/2017 3:25 PM PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: ,.100 2 0,?, CONTRACTOR:
LOCATION: ' I q ra 2 0 a'm 0 cIL,
TYPE OF WORK: u � e--
DATE INSP NEEDED: DATE INSP: Ij I�sI'7
INSPECTED BY: �?>
WORK IN
PROGRESS: L,.
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:_:.
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appi. No. ____.._TQWN_QF_SQUTN WINDSOR—P-UBL-IC--WORKS-DEPARTMENT Permit-No. -
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $2"0
Name of Firm CT Water Company �o- "e'
Phone No. 860 - 622 - 9562
Address of Firm P.O Box 857 East Windsor 5 North Rd Zip Code
Location of proposed work _
Describe fully nature of permit requested FXC to rpnpw wateriSN/C arroSS the road Que lane was left opinneli and
the SVC was pulled.
Starting date 9/10/2017 Call Before You Dig No
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Out ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water El Well Sewage Service; ❑ Public Sewer ❑ Septic
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Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by Town
No.cuts
1 Est. Patch Size(s) sf
1 Est. Pvt.Thickness in
Est. Patch Unit Price$_/sf
Est. Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
See attachedlll Est. Sidewalk Replacement sf
Est.Sidewalk Unit Price
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
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Est.Traffic Control$
7 , Amt.of Deposit$
Total Due$
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Applicant is responsible for contacting the Police Dept.and C.B.Y.D ( )Cash Check#
PERMIT SHALL BE,KWT-OAM BSITE 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 STREE CUT PERMIT MANUAL.
Signed: — -- ' Print Name ' Date:
Street Excavation Permit 2014
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