HomeMy WebLinkAboutStreet Cut Permits 100 Hemlock Avenue (2) 1600119 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 07/05/2016
GIS ID: 41350100 FEE: 0.00
MUNIS APPLICATION# 201600916 EXPIRATION DATE:
APPLICANT LOCATION
NAME: EVERSOURCE ADDRESS: 160-HEMLOCK AVENUE
ADDRESS: PO BOX 270 OWNER: EVERGREEN WALK LIFESTYLE CENTER
HARTFORD, CT 06141 2650°THOUSAND OAKS#3150
MEMPHIS,TN 38118
PHONE 860-292-2242
WORK DESCRIPTION: INSTALL GAS SERVICE TO NEW BUILDING
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYEXPENSES 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
7/13/2016 3:09 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
------------------ ----- -----------------------------
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: 16 oa// 9 CONTRACTOR: SJerSo u re e
LOCATION: kk 14Y 4\Jt o I -e__
TYPE OF WORK: S Tx 11 . TO
r -
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: k�
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C. DATE: - I
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 $25.00
Name of Firm ��21�cS p Uf`C,2_ Phone No. ,?[oy- 3 3 5 -5 a,S a
Address of Firm l 'I C—a'rf W I-n AS Zip Code O(DD R,3
Location of proposed work \L)d1 --- Avin,
Describe fully nature of permit requested t n s+q 1� Qo—s .S-2T'V1 C c� 4y new )fig,
Starting date'e.1C D-P 7:�Yu.lu Call Before You Dig No F 01 LeA(oU Lf ( 10
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: I0"No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
ii�� � C� Est. Patch Size(s) sf
G�i��i ri G +-�CLS �Q-�� "�
-�- I Est. Pvt.Thickness in.
c s v-N5 6 cl_S S'-U-b Est. Patch Unit Price
�cv�OS�oL Gas Sem(-P— - -A
Est.Patch Cost$
Est.Curb Replacement ft
I Est. Curb Unit Price$ /ft
ISO Est.Curb Cost$
�0 ( Est. Sidewalk Replacement sf
JCb Est. Sidewalk Unit Price$ /sf
I Est.Sidewalk Cost$
�---—� Est.Traffic Hours hr
,1 eJ
Est.Traffic Unit Cost$ /hr
O
Est.Traffic Control$
Amt.of Deposit$
DRIVEWAYS must be 3ft or more from the property line per Total Due$
section 2.17 of the Toning regulations
(
Applicant is responsible for contacting the Police Dept. and C.B.Y.D ) Cash ( ) Check#
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 FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDSOR' S EET CUT PE`�UAL.
� L
- - Signed: - -- -- ---_.. ---- -- -Print-Name n-e---(Cb T.___.
_. - Date,. Ol CQ