HomeMy WebLinkAboutStreet Cut Permits 1062 Pleasant Valley (2) 1600097 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 06/06/2016
GIS ID: 72901062 FEE: 0.00
MUNIS APPLICATION# 201600742 - "EXPIRATION DATE:
APPLICANT - LOCATION
NAME: EVERSOURCE ADDRESS: 1062 PLEASANT VALLEY ROAD
ADDRESS: PO BOX 270 OWNER: MAROUSKI ROBERT A
HARTFORD,CT 06341 1062=PLEASANT VALLE
SPUTH:WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: 12'X2'VAC HOLE EXCAVATION TO`REPAIR PEST BOX
APPLICANT AGREES TO FURNISH THE TORN OF SOUTH WINDSOR THE`AMC3UNT,OF$OND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANI� PENSES INCURRED BY THE AINTENANCE 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 TO WN`OF SOUTH WINDSOWS STREET CUT PERMIT MANUAL.
C
ISSUED B DATE INSPECTED INSPECTED BY
6/6/2016 11:58 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:; 16 6002 7 CONTRACTOR: E verb 0 refe
LOCATION: a L lea �ar�T 19tilltf�t i�d
TYPE OF WORK:./-,? 2 V,5 �i%P ���Vj A `� ��i/ �5�` ���•
DATE INSP NEEDED: DATE INSP: 2 2/�i
INSPECTED BY: o b
WORK IN
PROGRESS: I b
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT-
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSECfION REPORT 14
A-PPEI—CA(10 F6 sTREET--EXC�41�7�'i'101�1
A V. No. TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
__M__.1:54o-6ULL_IMAN-AVENUE.
n .. . SOUTH WINDSOR,CT,0074. Qate:
FEE $25.00
Name of Firm � t`C2 6N
Phone No. - -e f p
Address of Firm 12
�L^ SOS CT Zip Cod
Location of proposed work a �-{— f
Describe fully nature of permit requested — 2��Zt C
- baX
Starting date 11
—
Approx.time for completion
Call Before You Dig No.2gi2o?=Ztj'33OC(P Existing Water Supply: El Public Wat
❑Weif
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN.A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or fumish
two copies of separate drawing This section to be tilled out by
Indicate North TOwn of South Windsor
No.cuts
0
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$_.______/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
the Police De t.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 AS UTLINED 1 �TOWN006O WINDSOR'S STREET CUT PERMIT MANUAL
Signed: ('�`'�
T Date:Title: g 1"e 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-m
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The material contained on this map
shall be considered proprietary to Title:
Eversource Energy and user which is 1
defined as ceiv person a entity EVERS—URGE
who has received the map through ,^ �' t�`C
sale,purchase,exchange,gift,or Y L JJJ1�lGRGY
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therwise)shalt keep it In confidence
and shall not furnish or disclose it
to any third party without the prior Information shown is not guaranteed and Evemource Energy assumes no responsibility.
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written permission of Eversource Energy. Contractor:are urged to call Eversoume Energy for further Information at i-800-989—o900 Q e: — un—
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The material contained on this map
1 shall be con Energy proprieta to Title: J 7(f /] �j�- (
I Eversource Eide and user ghtich is �,/ 1 CI l��I l �
defined or any person or entry f VERS-URGE
who has received the map through ���}J/ j �� /. �
sale,purchase, exchange,gift, or S i "��, �,/ \J
otherwise)moll keep it in confidence ENERGY
and shall not furnish or disclose it
j to any third party without the prior Information shown is not guaron and Eversource Energy assumes no responsibility.
written permission of Everoource Energy. Controetors are urged to w,,Everwu, Energy for further informaUon at t-80o-989-0900 a e' — un—