HomeMy WebLinkAboutStreet Cut Permits 1060 Avery Street (3) 1500181 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 08/14/2015
GIS ID: 06301060
MUNIS APPLICATION# 201501102 FEE: 0.00
EXPIRATION DATE:
APPLICANT LOCATION
NAME: EVERSOURCE ADDRESS: 1060 AVERY STREET
ADDRESS: 112 PROSPECT HILL RD OWNER: -BURGIO--MARIO&LUCIA M
EAST WINDSOR, CT 6608$ -1060 AVERY STREET
PHONE 860-292-2242 SOUTH V�INDSOR,CT 06074
WORK DESCRIPTION: TEST HOB 8S IN EXSITING GAS TRENCH TO INSPECT FOR QUALITY
ASSURANCE 2X2 HOLE
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 WILI ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
8/14/2015 10:43 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:; CONTRACTOR: E yerSrgcz eC,,-
LOCATION: 1060
TYPE OF WORK: k & P 442ea "'c"r umv
DATE INSP NEEDED: DATE INSP: is " ' i
INSPECTED BY: .�j
WORK IN
PROGRESS:--- 14,
4 51. "X 'S
r
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT f,���dP J
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074 FEE $25.00
Name of Firm e. l 1 G h E t �r Phone No.
Address of Firm o c `� —�--_
Location of proposed work It1(� t4�/ery S� Zip Code_ r-�KZ.
Describe fully nature of permit requested i-e.s4
Starting date Call Call Before You Dig No
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut f/Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Shaw sketch of proposed work or furnish Indicate North This section to be idled out by Towntwo copies of separate drawing
No.cuts
< ,L Est. Patch Size(s) sf
� �L� Est.Pvt.Thickness in.
o Est. Patch Unit Price$ /sf
Est.Patch Cost$
i Est.Curb Replacement it
Est.Curb Unit Price$ /ft
Est.Curb Cost$
((q Est.Sidewalk Replacement sf
r off s
Est.Sidewalk Unit Price$ /sf
Est.Sidewalk Cost$
Traffic raffic Hours
hr
f
�'►� r� Est.Traffic Unit Cost$ /hr
f�4 Est.Traffic Control$
Amt.of Deposit$
DRIVEWAYS must be 311 or more from the property line per Total Due$
section 2.17 of the zoning regulations
Applicant is responsible for contacting the Police Dept.and C.B.Y.D O Cash ( )Check#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Paid By
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 1 AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDSOR�S STREEET�CUT PERMIT MANUAL.
Signed: Print Name
Date-
Street Excavation Permit 2014
�1 PRlMARK FORM
Locatlon����� Oycy y SA-.
Premark Dater i
Foreman NameEf-,k C�Y1 Ono i n
Digsafe# Date: a
Picture#
Circle all that apply
Private Property: Y ool J' avement to be broken\-�Ior N
Sidewalk� Stre t/Grass/Driveway
Police Detail Needed: Y o ie
Guaranteed Road: Y ozQ� What Year?
Draw Sketch Below