HomeMy WebLinkAboutStreet Cut Permits 154 Gail Lane (2) 1600095 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 06/06/2016
GIS ID: 34500154 FEE: 0.00
MUNIS APPLICATION# 201600740 EXPIRATION DATE:
APPLICANT LOCATION
NAME: EVERSOURCE ADDRESS: 154 GAIL LANE
ADDRESS: PO BOX 270 OWNER: LEWA,DOWSKI STEPHEN W&MARILYN C
HARTFORD, CT 06141 134 -GAll,LANE
SOUTH=WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: 1'Xl'VAC EXCAVATION IN GRASS TO REPS E. -TEST BOX
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH- INDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY-EXPENSES INCURRED BY THE T0W- N-FORMAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLI ILI
CANT IS FAMAR 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
6/6/2016 11:53 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
- -- --- - --------------
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:; O 9� CONTRACTOR: y6,fS&L)ref
LOCATION: 45-y &I
TYPE OF WORK: r SST D
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS.-
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: l i 16,
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
A-PPUCA-hofffOR
Appl.No. TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
-_:.._1 40 SIfGL1 AN-A�/ENI�E. ..._._ .- .... Date: '2-1 to
M ""A SOUTH W INOSOR,C'tf.B.Q74.
FEE $25.00
Name of Firm Pi 'e xur t 203-�Q �� (p�-
Address of Firm Phone No.
SD< Zip Code
Location of proposed work /
Describe full'nature of Permit
bOX requested Ptell Vo e_ -�1CCGLVG t o�
r
Starting date
Call Before You Dig No. ((��O �� Approx.time for completion L c
3 Existing Water Supply: ❑ Public WateP ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE OF-POSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE.
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN.A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish
two copies of separate drawing This section to be filled out by
Indicate North Town of South Windsor
ezma
, ps
No.cuts
0
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$______.^—/sf
Est.Patch Cost$
Est.Curb Replacement it
Est.Curb Unit Price$__�Ift
Est.Curb Cost$
Est.Traffic Unit Cost$.__/hr
Est.Traffic Control
Amt.of Deposit$
Total Due$
(Paid ash ( )Check#--_,
Applicant is responsible for contacting
the Police Dept.and C.B.Y.D. 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 WALL ABIDE BY THE RULES AND REGULATIONS FOR.
PERMITS AS UTLINED IN—THE TOWN OF SOUTH WINDSOR'S STREET CUT
//PERMIT MANUAL.
Signed: ��j Date:
Title: loY1 I
Driver's License#:2-1 (f.(o 2_ -tqo
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 oe REV 10-22-m
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who has rocerved the map through R
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sale,purchase,exchange,gift,or �/A� 9) �/y/J �■���
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and shall not fumt or disclose it ENERGY
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