HomeMy WebLinkAboutStreet Cut Permits 11 Kelly Road (2) 1600122 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 07/13/2016
GIS ID:49500011
MUNIS APPLICATION# 201600956 FEE: 0.00
hXPIRATION DATE:
APPLICANT LOCATION
NAME: EVERSOURCE ADDRESS: 11 KELY ROAD
ADDRESS: PO BOX 270 OWNER: US BANK
HARTFORD, CT 06141 3815=SOUTH WEST TEMPLE
PHONE 860-292-2242 SALT LAKE CITY,UT 84115
WORK DESCRIPTION: EXCAVATE TO INSTALL GAS SERVICE WORKING BEHIND THE CURBING
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 OUTLINE/D�IN THE�TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
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ISSUED BY DATE INSPECTED INSPECTED BY
7/13/2016 3:14 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: CONTRACTOR:
LOCATION: 1 k ec);'
TYPE OF WORK: A-pq k c0"
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DATE INSP NEEDED: DATE INSP: z 1,6"/4'
INSPECTED BY: o
WORK IN
PROGRESS: 0 F. :`5�e� ;`�► �..c� --�' C��u o�
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES [:] NO
AS-BUILT:
INPUT: DATE: I � `
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 $25.00
Name of Firm 'S S) a R,e2-E Phone No. 8 L Q^ 7 9 2. "— V S 6
Address of Firm Q S f IE C j Zip Code (�
Location of proposed work I I k -LILY
Describe fully nature of permit requested [-,)(CaY®)' E 'ro 1 tj 57"6 11 Cod J�'('YC./ 6
Starting date_ Call Before You Dig No
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: 'ISRE No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
0 No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
- Est. Patch Unit Price
Est.Patch Cost$
Est.Curb Replacement it
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Sidewalk Replacement sf
Est.Sidewalk Unit Price
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
DRIVEWAYS must be 3ft or more from the property line per Total Due$
section 2.17 of the zoning regulations
(Applicant is responsible for contacting the Police Dept.and C.B.Y.D )Cash OCheck#
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 STREET CUT PERMIT MANUAL.
Signed Print Name 'cI-IL—O lt 11r IZII914 ib m Dater r��a
Street Excavation Permit 2014
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The material contained on this map Title:
shall be considered proprietary to
Eversource Energy and user (which is
defined as any person or entity who has received the map through Energy EVERS ..URO
sale, purchase, exchange, gift, or Information shown is not guaranteed and Eversource
otherwise) shall keep it in confidence assumes no responsibility. Contractors are urged to call
and shall not furnish or disclose it Eversource Energy for further information at 1-800-989-0900 ENER6
IY
to any third party without the prior
written permission of Eversouce Energy. Plotted: 28—Jun-2016 By: gisewr1
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