HomeMy WebLinkAboutStreet Cut Permits 9999 Nevers Road (9) 1600025 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 04/05/2016
GIS ID: 62409999 FEE: 0.00
MUNIS APPLICATION# 201600355 EXPIRATION DATE:
APPLICANT LOCATION
NAME: EVERSOURCE ADDRESS: NEVERS ROAD&WOOD POND 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: INSTALLING TEST STATION ON GAS MAIN
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 FAMILIAR WITH AND'WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSO 'S STREET CUT PERMIT MANUAL.
ISSUED BY JDATE INSPECTED INSPECTED BY
4/5/20 1 6 2:21PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: J 000a? S CONTRACTOR: o Z°r-soo re,P
LOCATION:_ y o(s LV otgaIJ
TYPE OF WORK: �1
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 1�;b
WORK IN
PROGRESS: �7)c , , � f' �� •' i, -r `y ' i
c .
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: % DATE:
S/molloy/forms 2014'Town of South Windsor INPSEMON REPORT 14
y
APPMA110fffOR TR E'I` X XV 110.N-�PERMIT -- -_--.------
Appl.No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT �11
f)ate: `7-
SOUTH.WINDSOR,CT,,0074 .
FEE $25.00
Name of Firm �V�rSdUrC.e Phone No. �3-SCcO-a9
Address of Firm 2- S l 1 OS Zip Code
Location of proposed work W 60 n
F Describe fully nature of permit requested S e� Maw)
Starting date_ tP Approx.time for completion �--
Call Before You Dig No.22-Ua I LWO 340 Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑.Public Sewer ❑Septic
PLEASE NOTE: THE Q EPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN.A YEAR OF THE TEMPORARYPATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
S2� n')C(pS
No.cuts
0
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement It
Est.Curb Unit Price$ /g
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
a
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
i 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 I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS UTLINED IN T TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: `t
Title: (ffy Si Driver's Ucense#: 21t dA "-?D q
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 71MES
Street Excavation Permit o8 REV 10-22-M
8 J
NEVERS RD.
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The material contained on this map
shall be considered proprietary to Title: ,fl '00� I
Eversource Energy and user which is �J U r J �v (Jv 1 defined as any person or entity �� C who has received the map through ,p ' wO/� EVERSWUR\r►E
sale,purchase,exchange,gift,or U v S TV__' ��
otherwise}shall keep it in.confidence
and shall not fumish or.disclose It ENERGY
to ony third party without the prior Information shown is not guaranteed and E—urae Energy assumes no respansibli ky e"'•�°�'
written permission of Evemource Energy, aontmetore are urged to call Evere erource Energy for furth information at t-8oa— 9-09a0 a e: — pr—