HomeMy WebLinkAboutStreet Cut Permits 469 Graham Road (2) 1600096 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 06/06/2016
GIS ID: 37500469 FEE: 0.00
MUNIS APPLICATION# 201600741 EXPIRATION DATE:
APPLICANT LOCATION
NAME: EVERSOURCE I, ADDRESS: AW GRAHAM ROAD
ADDRESS: PO BOX 270 LAROCCO CHRISTOPHER J&JOANN E
HARTFORD,CT 06141 4i9-GRAHAM ROAD
SOUTH WINDSOR, CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: 12'X'zyACHOLE EXCAVATION-- - EXPO E&RAISE TEST STATION
APPLICANT AGREES TO FURNISH THE,TOWN OF SOUTH WINDSOk THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A�EXPENSE,S114 RED BYCUR THE YW OL-FORMAINTENANCE 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 WINDSOWS STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
6/6/2016 11:55 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO;.: CONTRACTOR: EVl0,r,5Q0 rC e_
LOCATION. ha l'n 0"64d
TYPE OF WORK:_ VA-C
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSECRON REPORT 14
A-PpacA moff-MASTREErf`X �1�74't'ro�11�ERM1r --- __-
Appi.No. TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
W.-LW..AN-�WENUE _-_..... Date: CP- ZP
° SOUTH WINDSOR,CT A:SA74.
FEE $Z.00
Name of Firm V-e(SourCe Phone No. �3` c0-2�} (o�
Address of Firm {_ (2 �. Zip Code p
Location of proposed work
Describe fully nature of permit requested - 2`x Z.rVZ16 Fy4e .exL
Starting date_ (o- -f 6 Approx.time for completion 1 C1
Call Before You Dig No.201(0 2ZC 2q 4 s Existing Water Supply: ❑Public Wate
❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE.
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or fumish
two copies of separate drawing This section to be fill--ed°ut by
Indicate North Town of South Windsor
Ste. mc�s
No.cuts
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$`_/sf
Est.Patch Cost$
Est.Curb Replacement,_ft
Est.Curb Unit Price$---/ft
Est.Curb Cost$
Est.Traffic Unit Cost$---�_mr
Est.Traffic Control
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police De t.and C.B.Y.D.
t 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 UTLINEO 1 TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: 1
Title' �l 1J1�1 1 e C�Jh 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 dOBSITE AT ALL TIMES
Street Excavation Permit 08 REY io-22-M
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The material contained on this map
shall beu considered proprietary to Title:
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defined ar any person ar enhro EVERS RCE
who has received the map through � `'
sale,purchase, exchange,gift,or 1 tj� 1{� Jj
otherwise)shall keep it in confidence ENERGY
and shall not furnish or disclose it
to any third Party without the prior Information shown is not guaranteed and Evenource Energy assumes no rcspansihiiia w�
'� written perrmss!on
of Eversource Energy. Contractors are urged to call Eversource Energy for further Information at t-80o-9s9-0900 a e: uz—jun—zvl