HomeMy WebLinkAboutStreet Cut Permits 130 Diane Drive (2) 1700223 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 10/23/2017 y
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GIS ID:28200130 FEE: 50.00
MUNIS APPLICATION# 201701494 4`` EXPIRATION DATE:
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APPLICANT LOCATION
NAME: EVERSOURCE ADDRESS 13(?DIANE DRIVE
ADDRESS: 112 PROSPECT HILL ROADA.
= OWNER THIBOl?EAU DONALD R TR&
EAST WINDSOR,GT 0R60 8 1�Q DIANE DRIVE
S }I7THVITINDSOR,CT 06074
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WORK DESCRIPTION: EXPEAVATEOT,OCATE/RpATI� IN I EIC`�LASg 2 WO#SE721974
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APPLICANT AGREES TO FURNISH TH&TOVN OFpUT�I WINDSOR TH1;AMOiINT`QE BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN.f,'EXPEN" ES 1.9dTJI 1�'.$Y THE TpW1�T FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND AE PT T ICAN I A " HE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOTJTH DS R':S STREET CiJT PERMIT MANUAL.
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ISSUED BY AIE INSPECTED INSPECT D BY
10/2312017 2:38 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1 c0;� CONTRACTOR:
LOCATION: 13 lit:i Vim.
TYPE OF WORK: L,0C.m,_1 Vie&,f fgiO 164k G h%
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: iil
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES NO
AS-BUILT:
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INPUT: DATE: i
S/mo!!oy/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 $50.00
Name of Firmn Phone No.
Address of Firm I lja=o f - Zip Code 0099
Location of proposed work 130 CYI
Describe fully nature,of permit requested 4n bm �Q �Gtll4 2..
Starting date Call Before You Dig No c I 1 03
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY
INCREASES,IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑Well Sewage Service: ❑ Public Sewer ❑Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
0 No.cuts
Est. Patch-Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
Est.Curb Replacement ft
Est, Curb Unit Price$ !ft
Est.Curb Cost$
Est.Sidewalk Replacement sf
Est.Sidewalk Unit Price$_/sf
Est.Sidewalk Cost$
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 -
( ) Cash O Check#
Applicant is responsible for contacting the Police Dept.and C.B.Y.D
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 ST T PERMIT MANUAL.
Signed: Print Name—A, C W� Date: f
Engineering/p rmits/Str t Excavation Permit 2017 ad 1::�
0.ERSSURCE LEAK C.LASSIFiCATIOIV 1 �,2•. ,El
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LEAK iQ E REP7 R IIIIIIIIIIIIIIIIIfICIIIIIIIIfIIII11IlI1
ELOW GROUND '` STATE 0 CT Q MA .
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DATE L4K FQUND. ! - ) TIME:�'+ For follow-up work on an existin lesk;.enter exstin
PRE=EXISTING;I EAK REPORT
CLASS 1:-INFORMAF IQNi
Normal Hrs
Off Hrs
MAINTENANCE
Time Reported to:Dispatch: Time OrrSite .
ALL GLAS$ONE-(1)LEAKS ARE Ta'9E REPORTED.IMMEDIATELY Consuit�is to standbji for Ev2rsource • MET�R`S RVIG �
firs f responder and.assist furt!*if needed:
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INCIDENT TYPE
SURVEY:TY.PE LEAK REPORTED BY METHOD
USED
Business District walking Gas Leak
Customer Flame Ion
�usiness.Dtstrtctmobile Damage With Power Equip-Gas Leak
Leak. C.G.[
CllWinter Patrol Excavator INSTRUMENT ID: ..
Mobile FirelPolice CALIBRATION DATE: € 7
Pre.Pave Passerby LOCATION OF LEAK HIGHEST READING
AK APPEA
Co-Employee LE . .. RS
Public BuIW69 TO BE ON r� Street
FOUND
Other LEL
Re Check yC Main Sidewalk
S ectal. , .. GENERAL LOCATION,
GAS ,f
PService. Lawn ;
Walking ` } Publ#c ROW` Valve .. ��Buslness
chool(within 50 ft Zone),., AREA MARKED
P Y DistrictPrivate Pro ettNo
Wh ite
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Include all pertinent information•-type of cover,sewer or drains in area,etc. r_ , 77 fti
ADDITIONAL INFO:
Leak ImFestigator's Narrte,,w•,,,... Company Name(if Vendor) r
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Su ervisor's Si nature
Leak Investigator's.Signature ,e ,�.....:.:_:_�.....__wP - ...9 _•.- :, „ ;a�.. _fi