HomeMy WebLinkAbout658 Pleasant Valley Rd - Permit, Inspection Report, Application, Sketch, & MDC Cut Sheet2000052
PERMIT NUMBER
TOWN OF SOUTH WINDSOR, CT
STREET CUT PERMIT
DATE: 04/28/2020
GIS ID: 72900658
MUNIS APPLICATION # 202000611
FEE: 50.00
EXPIRATION DATE: 04/28/2021
APPLICANT LOCATION
NAME: BUTLER COMPANY ADDRESS: 658 PLEASANT VALLEY ROAD
ADDRESS: 848 MARSHALL PHELPS ROAD OWNER: COSTA JOSEPH DAVID
658 PLEASANT VALLEY
WINDSOR, CT 06095
PHONE 860-688-8024
WORK DESCRIPTION: PERMANENT PAVEMENT RESTORATION FOR MDC
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 OpUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
4/28/20209:24 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
PERMIT NO.:
LOCATION:
TYPE OF
TOWN OF SOUTH WINDSOR INSPECTION REPORT
CONTRACTOR: .
(e
DATE INSP NEEDED: DATE INSP:�
INSPECTED BY: 6D
WORK IN
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS -BUILT: t�
INPUT: Gvv� DATE:
S/molloy/forms 2020 Town of South Windsor INPSECTION REPORT 20
1cc'GE,11 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 $60.00
Name of Firm C 1 d 13i !e f Phone No. &L
Address of Firm 1 r Zip Codes
Location of proposed work S l 1 (r //�
Describe fully nature of permit requested e r r"ar r :f �>�uv '" ,Pe c . „"" __ -
Starting
"r �— Call Before You Dig
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 Nfavement Cut ❑ Curb Cut I-]SidewalkCut
I`e5}r-671�t?�-
❑ 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
two copies of separate drawing
# -1/ly fie)
DRIVEWAYS must be aft or more from the property line per
section 2.17 of the zoning regulations
Applicant is responsible for contacting the Police Dept. and C.B.Y.D
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Indicate North
I This section to be filled out by Town
No. cuts
0
Est. Patch Sizes) sf
Est. Pvt. Thickness in.
Est. Patch Unit Price $ /sf
Est. Patch Cost $
Est. Curb Replacement ft
Est. Curb Unit Price $ /R
Est. Curb Cost $
Est. Sidewalk Replacement sf
Est. Sidewalk Unit Price $ /sf
Est. Sidewalk Cost $
Est. Traffic Hours hr
Est. Traffic Unit Cost $ Rv
Est. Traffic Control $
Amt. of Deposit $
Total Due $
( ) Cash ( ) Check fi
Paid By
---------•-•••--• •..�������,,,,�,vvvw rvK mnuv, CMINUM VK KCVAIK wURK IN CONNECTION WITH THIS PERMIT AND
THAT 1 AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WiNDSOSigned-: R'S SRMfT-MANUAL. print Name � /3y / lPt-
Date:
Engineerin ermits/street Excavation Permit 2017
m
i
57,y
O
5 7, :"" JY> g53
MD-039, Rev 2/12 o THE METROPOLITAN DISTRICT - PAVEMENT CUT / DATE:
ADDRESS 65 D P1�G50i UG (I�� �(I BILL JOB 0YES NO WO J KS� 3S %
1 /
CLOSEST STREET p,\lt-j.lell R8 TOWN 5WIND STATE HIGHWAY DYES IENO
-T!DRAW SKETCH S14OWING LOCATION AND SIZE OF UTS AND T MADE IN
CR(bSS SECTION OF PAVEMENT 1/
STREET L�, BITUM.--c2—' E CONC.—" ❑ PREMIX_'
❑SIDEWALK ❑BITUM._ DCONC._" ❑FLAG
O CURB ❑ BITUM._ D CONC._' ❑ STONE
G
El DRIVEWAY =BITUM._" DCONC. '
^C
❑ GRASS LOAM & SEED NEEDED ❑ YES CNO
REASON FOR CUT: A) / /l)n Pl� L-P.tiI
i
I I
3-0
b,p
y(i
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DEPTH OF EXCAVATION: h O
NUMBER OF CUTS:
DATE OF FIRST CUT: Lod S
IS JOB COMPLETED- YES ONO
FOREMAN: C Cr/,1�
REPLACEMENT PAVEMENT CONTRACT NO.:
t
BITUMINOUS ❑ CONCRETE::, PREMIX ❑
DATE COMPLETED:
ACCOUNT NUMBER:
CALCULATIONS
NQ,
'.. i
OF CUT ITEM # IT M# J Aftr. ITEM#