HomeMy WebLinkAboutStreet Cut Permits 9999 Griffin Road (2) 1600072 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 05/25/2016
GIS ID: 39009999 FEE: 0.00
MUNIS APPLICATION# 201600664 EXPIRATION DATE:
APPLICANT LOCATION
NAME: EVERSOURCE ADDRESS 9999 GRIFFIN ROAD
ADDRESS: PO BOX 270 OWNER: TOWN OF SOUTH WINDSOR
HARTFORD, CT 06141 1540'SULLIVAN AVE
= SOUTH WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: 4-I'X1'VAC HOLES TO REPAIR AND RELOCATE TEST BOX GRIFFIN RD
AT GRAHAM ROAD
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.
C,
ISSUED BY DATE INSPECTED INSPECTED BY
5/25/2016 3:17 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: CONTRACTOR: ,r 'Q-e1 S 0 �CE!
LOCATION: d 9 y9
TYPE OF WORK: C' .r I z/a. � Sr
DATE INSP NEEDED: DATE INSP: r /
INSPECTED BY: tit_,
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSECIION RtPORT 14
APPL1C741`IW FORSTR RM17`
Appl. No. ' TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
Permit No
L-.LI_YAN Avc-NUE.. .__.� - .. Date.:
_
SOUTH WINDSOR,CT:�tf607.4- .
FEE $25.00
Name of Firm ��"eYrJ0x7Y'C.0 Phone No. 20 > 5
Address of Firm �'oZ � C�St Sp( Zip Code��,
Location of proposed work hOLJ�
Describe fully nature of permit requested 4- �1 *�Vop—
Starting date - r Approx.time for completion
Call Before You Dig No. 21((n 1.dU t 5;(p0 Existing Water Supply: ❑Public Wate ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY '
COMPLETED WITHIN A YEAR OF THE TEMPORARY.PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or fumish
two copies of separate drawing This section to be filled out by
Indicate North Town of South Windsor
(��J No.cuts
0
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$
Est.Traffic Control$________`
Amt.of Deposit$
Total:Due$
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police Dept.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 1 AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS UTLINED I THE TOWN OF S WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: J--al�
t,, Date-
Title: 2���'tf,�J� Q 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 o8 REV 10-22-08
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The material contained on this map Tit 1 e. 1 1.•^
shall be considered propriety to
define as Energy and user (rywhich is ,_
defined as any person or entity EVE RS U ROE
who has received the map through <; tV�l�Y1�So
sole,purchase, exchange,gift,or ENERGY
otherwise) of f keep o in confidence ENERGY
and shall not famish or disclose it
i
to any third Forty without the prior Information shown is not guaranteed and Eversource Energy assumes no nssponsbilily sj6°'""'�'
[Iwo
permission of Eversource Energy. Contractors ore urged to call Eversource Energy for further information at t-800-989-0900 ate: _ Qy_
2016