HomeMy WebLinkAboutStreet Cut Permits 9999 Norton Lane 1700240 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 12/15/2017
GIS ID: 64809999 v ti FEE: 50.00
MUNIS APPLICATION 4 201701807 ggEXPIRATION DATE:
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APPLICANT' f � LOCATION
NAME: CONNECTICUT WA DER COMPANY ADDRIa35 u9999 NIJRTON DRIVE
ADDRESS: 25 NORTH ROAD F s OWNER ,: TOWN OF SOUTH WINDSOR
EAST WINDSOR,CT 0�6088 1540'S[JLLIVAN AVE
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PHONE 860-623-3355 Fw.
tE \h�II�1DSOR,CT 060742734
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WORK DESCRIPTION: REAAIRWA`Iall
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APPLICANT AGREES TO FURNISH THE TOWN OF SOUT�IUINI�SOR THI A A.
MOUNT Ole FOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANC'-I XPBNSES.INCURRFD;13t THI;TOWIOR`MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TiF APPIrICAI�T I IS FAMILIAR VWITH A1�TD WIC L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTI WNDSOR=.S 811EET GUT PERMIT MANUAL.
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ISSUED BY DATE INSPECTED INSPECTED BY
12/1 5/201 7 2:10PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: L
LOCATION: CCKY)f Char)r) ko(--�
TYPE OF WORK: Cc, m d►vi A icc, Y.-
DATE INSP NEEDED: DATE INSP: a 11 r
INSPECTED BY: Ap
WORK IN ,
PROGRESS: Cl C'�-,t- - -- -
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES 0 NO
AS-BUILT:
INPUT: DATE: 12 2 `�7
S/molloy/farms 2014 Town of South Windsor IMPSECTION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. 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 CT Water Company Phone No. 860 - 622 - 9562
Address of Firm P.O Box 857 Fast Windsor (25 North Rd) Zip Code
Location of proposed work CnrnPr of Charing Rd and Nortan La
Describe fully nature of permit requested Repair water main break.
Starting date 12/20/17 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: ❑ 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
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$0
/sf
Est. Patch Cost$
Est.Curb Replacement ft
Est. Curb Unit Price$ /ft
Est.Curb Cost$
Est.Sidewalk Replacement sf
Est.Sidewalk Unit Price
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( ) Cash ( )Check#F
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 STRTET/CUT PERMIT MANUAL.
Signed: �' Print Name G �' �`� � �� �:'l Date: of
Street Excava' n Permit 2014
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