HomeMy WebLinkAboutStreet Cut Permits 50 Bourbon Street (4) 1700025 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 03/07/2017
GIS ID: 12300050 =4 FEE- 0.00
MUNIS APPLICATION# 201700200 EXPIRATION DATE:
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APPLICANT i= 4 4 LOCATION
NAME: EVERSOURCE ADl RE $ ? %50'B0FURBON STREET
ADDRESS: 112 PROSPECT HILE'ROAD yOWNER ,r IMM>�R DEBRA
EAST WINDSOR,CT 0608
�4:; y5� B''CtiURBON STREET
5 SOUTH WINDSOR,CT 06074
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WORK DESCRIPTION: GAt SERVICE WORG I:I;OIVICU $ INF�4OiOUSE
APPLICANT AGREES TO FURNISH THL OWNil
f_F O17 TH'WTI41D ?R 1'HE21M(UNTOF$OND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY$MPENSES 1I�1C�IZ REI7$Y TI fE TOUVI±I FbTR1VIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND T1 iE ArPPLY� 1T I•`�FAIIARH A ]I3 WIf,L ABIbE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED 1N THE TOWN'CJF S()J PH WINDl-IN'S STREET CU I p11ZMIT MANUAL.
ISSUED BY DATE'INPECTED INSPECTED BY
3/7/20 1 7 3:53PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERmrr NO.: /-7aiVS CONTRACTOR: ,Cy-ef�
LOCATION: . '.
TYPE OF WORK: Qe,
DATE INSP NEEDED: DATE INSP: " ?
INSPECTED BY:
WORK IN
PROGRESS' J r r�r�'�I i�`,.: ��= lam.;,
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SEPTIC TANK.PUMPED,SMASHED,FILLED WITNESSED ❑YES ❑NO
AS-BUILT:
ORATE: '
S/mallay/forms 2414 Town of Sauth Windsor]NP511 CiTRERORT 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 $25.00
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Name of�F)frn Q. `- �; : . ,', ' s :P.hone'iVa �..-- .. ?
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: 1 ram Code.
Address afl=irlrt c . ,: _ "- :.
Location.of proposed wor 45r ' -
Describe fully nature of permit requestt:dIckh1l.. "IF.: ..T'Q- 1
Starting;date. 3: ^ / Call Before You Dtg No M�
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB::REPLACEMENT IS A:PRELIMINARY ESTIMATE. THE:
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND:CURB REPLACEMENT;INCLUDING ANY
INCREASES:IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS, THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THANA YEAR.
Check Applicable: No Pavements Curb or Sidewalk.Cut ❑ Pavement Cut ❑ Curt?Cut 0 Sidewalk Cut
Q Existing Driveway,No Changes ❑ Proposed Driveway:Widening O Proposed New Driveway
Water`Supply: ❑ Public Water ❑ Well Sewage Service- 13 Public Sewer 13 Septic
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Show sketch of proposed work or furnish indlCate North 'hf o to he#fllect arJtb 'gym.
two copies:.of sepaiate drawing
..'_. .., No,cuts.. .
Est. Patch Size(s) sf'
Est.Pvt.Thickness
Est..Patch Unit Price$.......:.....:.:..:...........:. ........:•I
Est.Patch Cost
i Est.Curb Replacement ft
Est:Curb Unit Price:$ lft
Est.Curb CosU; .
`i.Est.Sidewalk:Repl acement sf
Est.Sidewalk Unit Price$ lsf
Eet�Sidewalk Cosh$..
�;.ggt.Traffic':Hours:......-. ........ .. ..�•
Est.Traffic Unit Cost$ /hr
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j 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
( )Cash { }Check..# _
A:..pplicant is responsible for contacting the-Police Dept.and C.B.Y.D
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Paid 13y
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I.AGREE TO FURNISH TO THE TOWN OF SOUTH WINDS OR 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 OUTLINEII IN THE TOWN OF SOUTW
WINDSOR'S STREET CUT PERMIT MANUAL.
JM►>'.. Print Nam Ln�tia.� t4�19�'lflt�t. _ _ Dated
SiOttsdc.. . ,i.- e T
Street Excavation Permit 2014
W/ t7 $ 620 23b
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