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HomeMy WebLinkAboutStreet Cut Permits 423 Niederwerfer Road (2) 1500262 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER STREET CUT PUBLIC UTILITY DATE: 11/16/2015 GIS ID: 63600423 FEE: 0.00 MUNIS APPLICATION# 201501660 - EXPIRATION DATE: APPLICANT LOCATION NAME: EVERSOURCE ADDRESS: 423 NIEDERWERFER ROAD ADDRESS: 112 PROSPECT HILL RD' OWNER: SIRACUSA MATTHEW ALBERT& EAST WINDSOR,CT 66088 72 NATSISKY FARM RD SOUTH WINDSOR,CT 06074 PHONE 860-292-2242 WORK DESCRIPTION: EXCAVATE TO INSTALL GAS SERVICE APPLICANT AGREES TO FURNISH THB&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 11/16/2015 9:19 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** - - ---------- ------- r TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO:: l.S�D�a<v,� CONTRACTOR: Z 1/l5 C<5Q LOCATION: i ) + �e 4 TYPE OF WORK: DATE INSP NEEDED: DATE INSP: i INSPECTED WORK IN PROGRESS: SEPTIC TANK PUMPED,SMASHED, FILLED wrTNEsSED Fl YES ❑ NO AS BUILT: INPUT: DATE: © � S/moltoy/fcims 2014 Tom of South Windsor INPSECM REMRT 14 APPLICATION FOR STREET EXCAVATION PERMIT Appl.No. TOWN OF SOUTH WINDSOR Permit No. PUBLIC WORKS DEPARTMENT 1540 SULLIVAN AVENUE Date: SOUTH WINDSOR,CT 06074 FEE $26.00 Name of Firm Ro L tL8!�S aa? � / ��"Dt,(CCE Phone No. _ ` Z_ 2-' Z1 !TL9 Address of Firm__ 12 P a-t) a e ipc_ 7 N a l e U?i rJ1� f` �' Zip Code 0 b 0 a;13 Location of proposed work 3 A1.1 1� 9 Describe fully nature of permit requested_ '2� Starting date- J — Approx.time for completion 1 j9y Call Before You Dig No.A -f A 7 0 6 13 Z, Existing Water Supply: ❑Public Water ❑Well Existing Sewage Service: ❑Public Sewer ❑Septic PLEASE NOTE: THE DEPOSIT FOR.THE PERMANENT PAVEMENT PATCH AND CUR13 REPLACEMENT IS A PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE -PERMANENT PATCH AND CURI3 REPLACEMENT;INCLUDING.ANY INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC;CONTROL AND THE TOWNS CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY COMPLETED WITHIWA YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR. Show sketch bf proposed work or famish on two copies of separate drawing This secti to be filled out byIndicate.North Town.of.South Windsor No.cuts Est.Patch Sizes) sf Est.Pvt.Thickness in. Est.Patch Unit Price$ /sf Est.Patch Cost$ Est.Curb Replacement ft Est.Curb Unit Price$ /ft Est.Curb Cost$ Est.Traffic Unit Cost$ /hr Est:Traffic Control$ Amt.of Deposit$ Total Due$ ( )Cash ( )Check# Applicant is responsible for contacting Paid By i the Police Dept.and C.R.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 IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. Signed: Date: Title:. CO N cY zl' (4 Chi"La A) C IEz! 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 •'Z%X,�v'uiL:E� �.ik"]�tte.3'Si«:....`@�.).<o'�n; i I W l 9 i f.rz . 9 Errol M. A. Graham Construction Technician EVERS=URGE ENERGY 112 Prospect Hill Rd. East Windsor, CT 06088 860-292-2258 cell: 860-216-7013 errol.graham@eversource.com