HomeMy WebLinkAboutStreet Cut Permits 17 Carey Lane (3) 1500104 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 06/08/2015
GIS ID: 16800017 FEE: 0.00
MUNIS APPLICATION# 201500674 EXPIRATION DATE:
APPLICANT LOCATION
NAME: EVERSOURCE ADDRESS: 17 CAR11'LANE
ADDRESS: 112 PROSPECT HILL RD OWNER SCIIUMANN GARY W&DONNA L
EAST WINDSOR,CT 06am, = 17 CARE - LANE
SOUTH WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: INSER-'G1S SERVICE TCQFIX TEAK
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WINDSOI THE AMOUNT OF`"B4OND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYEXPENSES 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 O SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
410 /109
l
ISSUED BY DATE IN PECTED INSPECTED BY
6/8/20153:01 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: /S D� / CONTRACTOR: �fV LX
LOCATION: 1 a"V-.eQ bt
TYPE OF WORK: i Y %SA v/ cc IV � q
DATE INSP NEEDED: DATE INSP: rZ ,
INSPECTED BY: ?-)9
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
,awl
�p• No . a Y•v^ ' TOWN OF SOUTH WINDSOR H t tutu rcntvlt t
Permit No.
I .
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm �. 0 D u�E-C� Phone No.
Address of Firm_ 1 6 &'C.ram' t(ff I, 0 r I'U3 r1oCode-00098_
Location of proposed work_12 C..rQ F Lc\1 LA)
Describe fully nature of permit requested, ^C Y✓b�2� 0 g'l� S ( � (r'� �'��l�y°fC ti^
Starting date � f� Approx.time for completion
Call Before You Dig No. I 0/52. 3 o Z 6 92— Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑Public Sewer D Septic
PLEASE NOTE: THE DEPOSIT FOR-THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB-REPLACEMENT;INCLUDING.ANY INCREASES IN PATCH AREA,CURB
.LENGTH,TRAFFIC CONTROL AND THE TOWMS CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch bf proposed work or furnish This section to be filled out by
two copies of separatedr wing Indicate.North Town.of.South Windsor
No.cuts
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ 1hr
Est:Traffio Control$
Atnt.of Deposit$
Total Due$
( )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 Akt 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.
Signed: /
Date:- b '""
Title: .C--O tj S N-f-, .1 e-T l j) N 'itC Driver's License#:
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTI=R.APPLICATION FOR ISSUANCE OF PERMIT
WORK MAY NOT BEGIN UNM A PERMIT HAS BEEN'ISSUED -
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08 REV 10-22-08
4
22 -_
.75" ST I P 1982