HomeMy WebLinkAboutStreet Cut Permits 90 Beldon Road (5) 1500192 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
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DATE: 09/01/2015 4
GIS ID: 09300090 yes` FEE: 0.00
MUNIS APPLICATION# 201501180 a ~� c 7* �I?ZRATION DATE:
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APPLICANT;` sRt" E 'a4 4 N4h'�y n4Y LOCATION
NAME: EVERSOURCE r �11DIS 9Q L�ON ROAD
ADDRESS: 112 PROSPECT HIL 'AN 4 y� a O�E TCIRKIN`'�'TON DANIEL&
EAST WINDSOR CV'b60I18
SOWN ROAD
�4 H�Js4 �yy t. l (�UTI =VINDSOR,CT 06074
PHONE 860-292-2242 k
EXC DWORK DESCRIPTION: r ke
APPLICANT AGREES TO FURNISH THE T WOOF S®T�"I3HDRT�AMOT � (3 �D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WTNDSOR FOR A7 L1'Ei1iaI
SS IURIFEI $�I�TQ11�f 0 1AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH �APtrLICA `f IS ItAMIIIAC V1TI'ICN'� I F ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS A5 OUTLINED IN THE TOWN OF SOUTH S DSOR�?S$ REIT(~TI IT MANUAL.
ISSUED BY D `I;E Ih1=SPECTb SPEC 'ED BY
9/I/201511:55AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: _ AS-C) CONTRACTOR: K 1M rSQ_-�I2 C e
LOCATION:
TYPE OF WORK: exca oa,�e Tp mole coca � _2r 66e
DATE INSP NEEDED: DATE INSP: 217 117
INSPECTED BY: �
WORK IN
PROGRESS:_ e �. �
90
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No,
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Nam of Firm 6�IL o L 0-A.14,gM a o U A C_if Phone No. '$b-0 .2-t Z w ZZ 5
Address of Fir f,8 J-"r W 1011 D c Zip Code
Location of proposed work
Describe fully nature of permit requested r CUkv' 6' Al j8 f S
R- S J
Starting date f _ 15 Approx.time for completion A
Call Before You Dig No.!)- 1 0 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 bf proposed work or furnish This sectio}�to be filled out v
two copies of separate drawiisg Indicate.North Town.ot.SoluthYffndsor
No.cuts
Est Patch Sizes) sf
Est Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement It
Est,Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$
r - -
Est:Traffic Control$
Amt.of Depostt$
Total Due$
( )Cash ( )Check#
-i Applicant is responsible for contacting Paid By
the Police Dept.and 0.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 OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL
Signed: -Date: 0_/ S_
.. _
Title:. 1J S U L ti C Driver's License#:
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 y
Street Excavation Permit 08 RED/10-22-08
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