HomeMy WebLinkAboutStreet Cut Permits 735 Avery Street (2) 150OQ06 TOWN O F SOUTH U
PERMIT NUMBER T H WINDSOR, C T
DATE: 02/20/2015 STREET CUT PUBLIC UTILITY
GIS ID: 06300735
MUNIS APPLICATION# 201500140 FEE:
EXPIRATION DATE: 0.00
APPLICANT
NAME: EVERSOURCE LOCATION
ADDRESS: 112 PROSPECT HILL RD ADDRESS 735 AVERY STREET
EAST WINDSOR, CT 06088 OWNER: VASSALLO GLORIA R
735 AVERY STREET
PHONE 860-292-2242 SOUTH WINDSOR, CT 06074
WORK DESCRIPTION: REPAIR GAS LEAK
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 WINDSOR'S STREET CUT PERMIT MANUAL.
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ISSUED BY a
DA E INSPECTED
2/20/2015 2:09 PM *** INSPECTED BY
PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I-S'000 o CONTRACTOR:
LOCATION: -73�5-
TYPE OF WORK:_
DATE INSP.NEEDED: DATE INSP:
INSPECTED BY: 6A
WORK IN
PROGRESS: 'rc E Lj 6 L s Valve t, I A
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT: -
INPUT:_ t DATE:_
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
1ArrL1trH I IVIV rVK %Ip I Krt:I CAL;AVHI IU14 I'CKIVII 1
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.A4
Name of Firm It' Gty"'C. Phone No. 'Ea --�►a�!�
Address of Firm / Zip Code
jM
Location of proposed work
Describe fully nature of permit requested (<
Starting date
Approx.time for completion
Call Before You dig N .& j.-5i2860 8, _/ Existing.Water Supply: ❑Public Water ❑Well
Existing Sewage Service: D Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE- THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT'PATCH AND CURB-REPLACEMENT;INCLUDING ANY INCREASES IN PATCH AREA,CURB
.LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or famish tio This secon to be filled out by
two copies of separate drawing.: ..In�cate.North Taw to Soufh Windsor
' No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.'Patoh Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
EsL Curb Cost:$
4
Est..Traffic Unit Cost$ /hr
C> G/}s rTal
Est:Traffic Control
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police Dept.and G.B.Y D..
1 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
PERMITSA O TLINED IN. HE OWN OF SOUTH WINDSOR'S STREET CUT P RMIT NUAL.
Signed: -' Date:r Oft-- �' a d
Title:_ t 1t! 1 ie G� • Driver's License#
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OF PERMIT
WORK MAY NOT BEGIN UNTIL A PERMIT HAS BEEN ISSUED
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08 REV 10-22-08
CO
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