HomeMy WebLinkAboutStreet Cut Permits 9999 Avery Street (10) 1500164 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 08/04/2015
GIS ID: 06309999
MUNIS APPLICATION# 201501033 FEE: 0.00
EXPIRATION DATE:
APPLICANT LOCATION
NAME: EVERSOURCE ADDRESS: AVERY-STREET
ADDRESS: 112 PROSPECT HILL RD OWNER: TOWN OF SOUTH WINDSOR
EAST WINDSOR, CT 06088 1540;SULI IVAN AVE
SOUTH WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: RELOCATE GAS MAIN AND SERVICES ON AVERY,ST DUE TO TOWN ROAD
RECONSTRUCTION PROJECT
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 V SPECTED BY
8/4/2015 10:13 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:; CONTRACTOR: �E'ye"6 jYC e
LOCATION: 9 9 4 q A y&( !� S-Wrpjr
TYPE OF WORK: fe I D<f.4-P Arlo vTv'+n rr Sep'y, w-s :W wwv
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: J'J P
WORK IN
PROGRESS: woaX vAC, .tlFrnF�l �(�Cx.� AV ���-'
SEPTIC TANK PUMPED, SMASHED, FILLED D j .j WITNESSED ❑ YES [:] NO
AS-BUILT: WA
INPUT: - DATE:
S/molloy/forms 2014 Town of South Windsor INPSECTION 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 $25.00
Name of Firm Ya*Q-2 Gas Phone No. f36° '29 z-22 t9
Address of Firm l i Z I�r�s d- � 2o�d , F r.�sfi +nl� a-� C-'T 060_' � Zip Code 0&0'76
Location of proposed work J4�✓y �N���i"F W�d�(�*+� 'P��'�� �t�edZes
Describe fully nature of permit requested 12e_(oc.-4e c,mS sed«i'c. S Ale_ 40
_.111 IP6sk'_coo, t , "
Starting date Wzytl<- Call Before You Dig No OP)5 3
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut Vvement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies_s of separate drawing
No.cuts
�jaS t=q2,pa7QtTc�- --how. Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ !sf
GAe3 �y.T
Est.Patch Cost$
GA-* �+
Est.Curb Replacement ft
SIC 6&5 NW4 t Est.Curb Unit Price$ Jft
1
1 1— Est.Curb Cost$
_
Est.Sidewalk Replacement sf
Est.Sidewalk Unit Price
T� ib ZV" "' dlift-t Est.Sidewalk Costri $
Est.Traffic Hours hr
p Est.Traffic Unit Cost$ mr
l�iST
a"AWPJ � Est.Traffic Control$
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 I AM F&h ILIAR WITH AN WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDS STR UT P T MANUAL. �/►
Signe Print Name — h'''S\-'s '" �c 1 Date:
Street Excavation Permit 014