HomeMy WebLinkAboutStreet Cut Permits 45 Bourbon Street (3) 1500268 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 11/20/2015
GIS ID: 12300045 FEE: 0.00
MUNIS APPLICATION# 201501722 EXPIRATION DATE:
APPLICANT LOCATION
NAME: EVERSOURCE ADDRESS: 45 BOURBON STREET
ADDRESS: 112 PROSPECT HILL RD OWNER: SIMAO FRANK A&KAREN-ROSE
EAST WINDSOR,CT 06088 45 BOURBON STREET
SOUTH WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: REPLACE EXISTING GAS SERVICE
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.
ISSUED BY DATE INSPECTED INSPECTED BY
11/20/2015 8:49 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: /-5-0 19olb<. CONTRACTOR: ClA-clSd t1Y
LOCATION: rw►
TYPE OF WORK:-
DATE INSP NEEDED: DATE INSP:
INSPECTED BY.,
WORK IN
PROGRESS: ficr�so ,�e ��falL ,� 'Si2,� Sir ,
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED 0 YES ❑ NO
AS-BUAT:
INPUT: C > DATE: -16
S/moby/forms 2014 Town of South Windwr INPSEMION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: (::;2 - 1 3 1 S
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm� L�-rC 0___ Phone No. c6&U -3 3 S -5 Z_82.
Address of Firm eAL-. 2,'�.S .lp__( H-1,J Zip Code OC->o
Location of proposed work
Describe fuiiy nature of permit requested i� C�-� a @ �; tJr� C
Starting date_ ,SaD Approx.time for completion
Call Before You Dig No.,a0/514-)o3g70 Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
`�✓ Est. Patch Size(s) sf
Est.Pvt.Thickness in.
Est. Patch Unit Price
Est.Patch Cost$
$p Est.Curb Replacement ft
�(��' Est.Curb Unit Price$ /ft
Est.Curb Cost$
__�____...._l_ --�-•-- --"�"`1" Est.Traffic Unit Cost$ /hr
L Est.Traffic Control$
bUj Amt.of Deposit$
c
- -- - I L Total Due$
{ )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.B.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 A UTLINED 1N TH TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date:
Title: 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