HomeMy WebLinkAboutStreet Cut Permits 9999 Rye Street (8) 1500209 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 09/14/2015
GIS ID: 78609999 z 144V
MUNIS APPLICATION# 201501261 FEE: 0.00
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PI RATION DATE:
APPLICA IT
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NAME: EVERSOURCE JAW
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ADDRESS: 112 PROSPECT HILfiRI ' �� ADDRI S ,` vgA91xE STREET AT TROY ROAD
EAST WINDSOR, 8 �t� y SOER y ?TOWN`�F SOUTH WINDSOR
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INDSOR,CT 06074
PHONE 860-292-2242 ja' �, yTF wry, y S� HV
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WORD DESCRIPTION: 1N5t I*1 £, WOIT P��(jC
TtaEI ON GAS MAIN
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APPLICANT AGREES TO FURNISH THI 0�1�0 OU 4
�TT " 77j $� 1 A Tu ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDS012 FOR AN�YSiCB�ETsT,SES IJU i ,
IN
CONNECTION WITH THIS PERMIT AND TIC-AP k T,I tjz�=LxTs D L�ABIDE BTENY THERUCE OR LES AND REPAIR GULATIONS
FOR PERMITS AS OUTLINED IN THE TOWNb'8 w-Y WIND SOg.:S ST EIZ VIIT MANUAL.
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ISSUED
DATE SPECTED INSPECTED BY
9/14/2015 12:13 PM *** PERMIT TO BE KEPT.ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO..; CONTRACTOR: IE Ve r. Q c� C e-
LOCATION:_ R9 t 9 Aye strfe-2: f"
TYPE OF WORK: X o'l a s .
DATE INSP NEEDED: DATE INSP: I l L2_
INSPECTED BY: �t
WORK IN
PROGRESS: 4. 0-7-1,� � k C
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/fiorms 2014 Town or South Windsor INPSEcnoN REPORT 14
APPLICA'hON-FOA-ST EEE7`fXO-VA--T tptPERiVII"t`--- - -- _� --_-
Appl.No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
AVENUE
SOUTH WINDSOR,C-OA074. . -
FEE $25.00
Name of Firm m(b Ura_ Phone No. �J-J&()`3q6
Address of Firm /Z C Zip Code-s�
Location of proposed work (� �,�.
Describe fully natureof permit requested k.� L
Starting date Approx.time for completion 7 d 'a
Call Before You Dig No. �i Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY.PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filied out by
two copies of separate drawing Indicate North Town of South Windsor
craps No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost-$-
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
5�
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 I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS OUTLINED THE TOWN O`FSUUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed Date:_- _�
Title: C'Ic^c-cave Driver's License#: 2 /
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 08 REV 10-22-08
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shall he considered proprietary to
Eversouroe Energy and userwhich is
defined as any person or entity �Aso
who has received the maP through &)�x IIVVVJJ�� \1 ^..i C::r,�'� -�? �' *' �I r;I
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to any third arty w'dhout the prior leformatiw sAawn c of guaronteed and Eversaaron Energy ocsumes no rcspona�il�
written permission of Eversourae Energy. Controcfore are urged to aoll Evereource Energy for further information at t-800—s79—OB00 OW. — ep—
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Eversource Energy and user(which is
defined as any person or entity (�
who has recewed the map through s i`sale,purchase, exchonga.gift,or
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erwise)shot!keep iin confidence
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any third party without the prior Information shown is net guaranteed and Evenmurce E—av assumes ootten permission of Eversource Energy. ContmdAm are urged to call Evereource£ner,fa further hlformoNon at 1-800-1 —0a00 Data: — ep—
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