HomeMy WebLinkAboutStreet Cut Permits 18 Dart Hill Road (2) 1500276 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 12/10/2015
GIS ID: 25800018 FEE: 0.00
MUNIS APPLICATION# 201501797 - EXPIRATION DATE:
APPLICANT - LOCATION
NAME: EVERSOURCE ADDRESS: 18 DART HILL ROAD
ADDRESS: PO BOX 270 OWNER: MAZZARELLA ANTHONY
HARTFORD,CT 0614I 18 DART HILL ROAD
SOUTH WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: INSTAL-LING 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
12/10/2015 9:58 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
- - - -------------- - ------
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:; CONTRACTOR:
LOCATION: 1 -r 1 I Q�Q
TYPE OF WORK:
67
DATE INSP NEEDED: DATE INSP:IZA ls'
INSPECTED BY: Q
WORK IN
PROGRESS: Gaa- rL,, yCoad LL'u 't -j-,42_50,
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 006074 FEE $25.00
Name of Firm �✓eI to-te ga — GC"S Phone No. O(p0" 7 l Z."3S~ /C/
Address of Firm_ J I Z rOSDeGl- 14111141. 1 ��✓1dSo� Zip Code
Location of proposed work 'g Dat+ 14 i I 1 P
Describe fully nature of permit requested �nS ��i!11 �a4 sef t)rcQi
Starting date 12 r Call Before You Dig No ZOG 5001 gy5
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ WeJI Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
I Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
w. Est. Patch Cost$
I Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
I Est.Curb Cost$
I
I Est. Sidewalk Replacement sf
I
Est.Sidewalk Unit Price$ /sf
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
l tt tt QQ Amt.of Deposit$
R0A, Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting the Police Dept.and C.B.Y.D
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Paid By
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 IN THE TOWN OF SOUTH
WINDSOR'S S R ET CUT P RM MANUAL.
Signed: qU4 Print Name � � � Date:
Street Excavation Permit 2014