HomeMy WebLinkAboutStreet Cut Permits 9999 Beelzebub Road (4) 1500166 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 08/04/2015
GIS ID: 09009999 FEE: 0.00
MUNIS APPLICATION# 201501035 EXPIRATION DATE:
APPLICANT LOCATION
NAME: EVERSOURCE ADDRESS: 9999-BEELZEBUB ROAD
ADDRESS: 112 PROSPECT HILL IUD OWNER TOWN OF SOUTH WINDSOR PUBLIC
EAST WINDSOR, CT 06088 157 BURGESS ROAD
SOUTH WINDSOR, CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: RELOCATE GAS MAIN AND SERVICES ON BEELZEBUB DUE TO
TOWN ROAD RECONSTRUCTION PROJECT`
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BQND 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 WILT;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 PECTED BY
8/4/2015 10:39 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /�S�®d���P CONTRACTOR: Z'O e(--5e) j rr
LOCATION: R ct °l fee)Zf"b I2 c Q
TYPE OF WORK: ie D
DATE INSP NEEDED: ��-?�--[�' DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: FiAJ'AL- IPAv � rAb-Ar>. A.S FA0 �--
SEPTIC TANK PUMPED, SMASHED, FILLED 1Q/A WITNESSED ❑ YES ❑ NO
AS-BUILT: N/
INPUT: C LM 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 06074 FEE $25.00
Name of Firm Yal)kec Gas Phone No. 060--29z-2,21q
Address of Firm 1 l Z P,,.s cf- C--T 060-'3s Zip Code O&O'76
Location of proposed work 1 53�'��`�f� (g' Dt-�V'- �f Zed
Describe fully nature of permit requested l��a�Fe �,a s A,L—t L o%A A sWV1-Ce.S Ae. 4�21
Starting date P. zyt l"�- Call Before You Dig No 3 )
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 Vvement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two co iep__s of separate drawing
$�A F-rAQ*a> No.cuts
f �"02.�P1T - ( --� Est.Patch Size(s) sf
Est.Pvt.Thickness in.
I Est.Patch Unit Price
S� l�� MA,trl
Est.Patch Cost$
r.A
Est.Curb Replacement ft
Est.Curb Unit Price
1
Est.Curb Cost$
- - - - a —
Est.Sidewalk Replacement sf
.,�•�'ST�� I
Est.Sidewalk Unit Price$ /sf
cATe� b � Est.Sidewalk Cost$
643 A0V ttJ � � 1P42P-50>
j C*S Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
OA0 Awty Est.Traffic Control$
Y Amt.of Deposit$
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 1 AM F ILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDS STR T UT P T MANUAL. ^/�
Sig
ne Print Name ''S\' S '' 1� 1 Date: r 1f�
Street Excavation Permit 2014