HomeMy WebLinkAboutPleasant Valley Rd - Permit, Inspection Report, Application, Sketch, & Map1900196 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/15/2019
GIS ID: 72909999
MUNIS APPLICATION # 201902358 FEE: 50.00
EXPIRATION DATE: 10/14/2020
APPLICANT LOCATION
NAME: NORTHERN RAIL SERVICES ADDRESS: PLEASANT VALLEY ROAD
ADDRESS: 175 CIRCUIT AVENUE OWNER: TOWN OF SOUTH WINDSOR
WEST SPRINGFIELD, MA 01089 1540 SULLIVAN AVE
PHONE
WORK DESCRIPTION: TWO DAY ROAD CLOSURE TO REBUILD RAILROAD CROSSING
ON PLEASANT VALLEY RD
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 OUTLINED IN THE TOWN OF SOUTH W INDSOR'S STREET CUT PERMIT MANUAL.
INSPECTED BY
10/15/20193:13 PM \ ***PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSORINSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: - _
INSPECTED BY:y
WORK.IN
I ,< % s 1a
SEPTIC TANK PUMPED, SMASHED, FILLED - WITNESSED ❑ YES ❑ NO
AS -BUILT: `
INPUT:\
DATE:
S/moiloyJforms W Town of Saolh V)WsorMpsS dN 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 $50.00
Name of Firm N 0 2=� 1-1 r Z&( M L S r- G I L ta- S Phone No. 3 i 3- 3 4 3' ( 3g1 `{
AddressofFirm 1-7s W Sf)FLb 61q0 zip Code Old
Location of proposed work PL rjgS 1, 1'i V)qj-L C / CO
Describe fully nature of permit requested Z. QA / eAV (-L02)�C 12 Iv - LIL 'o
Starting
Call Before You Dig
/ 2_-
PLEASE NOTE: THE DEPOSIT FOR APPLICANT EPERMANENT REPLACEMENT THE
IICANTT IS RESPONSIBLE FOR EFU FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT, 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 9 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
two copies of separate drawing
0+1r-I to ITS^ 44. ALU-0 --a--- -
Wo?-L %
AtC..A
34"L x 20' (W
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
This section to be filled out by Town
No. cuts
Est. Patch Size(s) _sf
Est. Pvt. Thickness . in.
Est. Patch Unit Price $
_Isf
Est Patch Cost
Est. Curb Replacement ___ft
Est. Curb Unit Price $
_/ft
Est. Curb Cost $_
Est. Sidewalk Replacement
sf
Est. Sidewalk Unit Price $
/sf
Est. Sidewalk Cost $
Est. Traffic Hours
hr
Est. Traffic Unit Cost $
/hr
Est. Traffic Control $_
Amt. of Deposit $ _
Total Due $
( ) Cash ( ) Check#
Paid By
—_- I AEI CA nail IAG 691TN ANn WII I ARInF RY
EXPENSES INCURRED BY THE TOWN FUH MAIN I tWNUt un ncrnin -....... - -- -- -- -
THE RULES AND REGU IONS FOR PERMITS AS OUTLINED IN THE. TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: �(>/"✓I20�-- Print Name M1Gt Oki- y (���% )'i12S
Engineering/p rmlts/Street ccavation Permit 2017
Date:-_ / / /
TOWN OF SOUTH WINDSOR
ENGINEERING DEPARTMENT
ADDRESS
INSPECTOR
INSPECTOR
111
PERMIT NUMBER
TEMP. PATCH DATE
COMPLETION PATCH DATE
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