HomeMy WebLinkAboutStreet Cut Permits 23 Cliffwood Drive (3) 1500103 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 06/08/2015
GIS ID: 21000023 FEE: 0.00
MUNIS APPLICATION# 201500673E3PIRATION DATE:
APPLICANT -29
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NAME: EVERSOURCE i
Al �� F „ �� �>� Ir` ' 2FWOOD DRIVE
ADDRESS: 112 PROSPECT HILL t JW�NER y � fipERS N WILBUR L&RACHEL L
EAST WINDSOR,CT Q6�&8 T� �i u\ ,r �4 * �x3�� FI?FYOOD DRIVE
SOR, CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: IN8TIII�,L--AS RUIt3 n 7 Sa N ;
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APPLICANT AGREES TO FURNISH THE 1 WN pJF?$G7UTH 1�JND ISQI2 I1HL IOU1kJ 1 BO1 D REQUIRED AND TO REIMBURSE
OF,THE TOWN OF SOUTH WINDSOR FOR AN �R3NSESlINNt V TENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE PpICAN'I`T'S'FLIARVT II,AID'WIIBIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OIY OIfTH WINDS R' ST ET- IT I} R T MANUAL.
ISSUED BY DAT INSPECTED h INSPECTED BY
6/8/2015 2:55 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: ILSOo/ -3 CONTRACTOR:
LOCATION: Z� l/ b4)Ca0
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TYPE OF WORK: �S-,q( V l L�
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED [-] YES' ❑ NO
AS-BUILT:
INPUT: DATE: 5
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
1500103 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 06/08/20I5
GIS ID:21000023 �aR FEE: 0.00
MUNIS APPLICATION# 201500673 RXIRATION DATE:
fi�h
APPLICAN 'S )T f 5 w
NAME: EVERSOURCE "'� >``' 1�F ' y�' l �y��� ' �, LOCATION
tzi�DDRSE,> 2IF�W00D DRIVE
ADDRESS: 112 PROSPECT HILL Rt" �(t NER a '
�u �1IIDERS N WILBUR L&RACHEL L
EAST WINDSOR,CT 10,60,9 OOD DRIVE
'" 4 SQITHTDSOR,CT 06074
PHONE 860-292-2242 R s � r
WORK DESCRIPTION: INST,jLL�A;SRVIC4
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APPLICANT AGREES TO FURNISH THE TWN,OFi SdUSIH WINDSt1? T AMbUIV�'�bir BfJI REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANEW NSES INRRI I7 B TI1 TOW11 F�ORxN1 ` TENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THAPPL1' IS FMIIIAR WT'I HrAND VVII I; BIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN 0 U H{V1I�TDSORIS ST I✓ I) 1 T MANUAL.
ISSUED BY bXTy94NSPECTED INSPECTED BY
6/8/2015 2:55 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: 00/f' CONTRACTOR _ L
LOCATION:
TYPE OF WORK: �nSIX SV(✓ I L
DATE INSP NEEDED: DATE INSP: '
INSPECTED BY: e'er
WORK IN
PROGRESS: 149.�+.� �✓� l" i:kk
I
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: DATE: 5
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
•• �.vra■ ava� " W,1, V 1 ill—L—1 i../\LR1Y/111V11 i'l�IllYlll
Appl.No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm p C e, C_
Phone No. D 2— 2 2-Z 5 3
Address of Firm LIL 4tltr t1 Zo Code 06 03,8
Location of proposed wo t- (o p
Describe fully nature of permit requested L�X CAY A)--r 1j �l( S see vIc
Starting date Approx.time for completion
Call Before You Dig No.a D l 13 D Existing Water Supply: ❑Public Water ❑Well
-- - __ - -----_ -- __-- Existing Sewage Service: ❑Put2lic Sewer Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT"PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
-PERMANENT PATCH AND CURB REPLACEMENT;INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC;C014TROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD 13E LATER THAN A YEAR.
Show sketch bf proposed work or fumish This section to be-filled outby
two copies of separate drawing Indicate.North Town of.South Windsor
No.cuts
Est.Patch Size(s) —St
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /st
Est Patch Cost S
Est.Curb Replacement >t
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /Itr
Est.Traffic Control S
Amt.of Deposit$
Total Due S
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.&Y.D.
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 N THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: 3 �/S Date:
Title:_. � 7 I�IL CJ L��� /U �,�C 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 OS REV 10-22 08 C)
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shall be considered proprietary to Title:
Eversource Energy and user(which is
defined received any person or entity EVERSAS"'
�
who has hase, the map through Information shown is not guaranteed and Eversource Energy
sale, purchase,exchange,gift, a assumes no responsibility. Contractors are urged to call
R C E
othPrwlse}shall keep it in confidence �
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to any third party without the prior
written permission of Eversouce Energy. Plotted:03-,lun-2015 By:gisewrl
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