HomeMy WebLinkAboutStreet Cut Permits 79 Wentworth Drive (4) 1800012 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DA
TE: 02/28/2018
GIS ID:93300079 3 FEE: 50.00
MUNIS APPLICATION# 201800244 XPIRATION DATE:
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APPLICANT
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OCATION
NAME: EVERSOURCE ADDRESS 79 VVENTWORTH DRIVE
ADDRESS: 112 PROSPECT HILI:.ROAD ¢WNER GL,ASSER MATTHEW J&
EAST WINDSOR,CT Q4D8$ 79 WEITWORTH DRIVE
6010TH VINDSOR, CT 06074
PHONE
WORK DESCRIPTION: REPAIR S$RVI E `~
APPLICANT AGREES TO FURNISH THE TOWN ClF SOUTH WIND OR TIDE AIvIOU ITa f BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY$7EISES IICCIItREp BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND ThE APPI ICANT IS FAMILIAR V ITI3 AND W1I.L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN CSFSOUTH W2NDSORS'°S TREE T C[TT. ERMIT MANUAL.
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ISSUED BY DATE ```S`EECTED INSPECTED BY
2/28/2018 11:35 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: . DpD CONTRACTOR: V e-
LOCATION: W 12J D ,&—
TYPE OF WORK: v,
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS' 4c,
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: C Or - DATE: ~e `
5/m6lloy/forms W14 Town of South Windsor IIVPSEMON REPbP.T 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl, Na. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
p TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074 FEE $50.00
Name of Firm GV ICC Phone No._��� OF�'
Address of Firm Ro.rk«` iC.L Zip Code
Location of proposed work 7 2 0E two#—Tw 1�R I
Describe fully nature of permit requested
Starting datePZ
Call Before You Dig No_
1
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE i
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES-IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD 85 LATER THAN A YEAR.
Check Applicable: /A,No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Publie Water ❑Well Sewage Service: ❑ Public Sewer ❑Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
l/ 0No.cols
Est. Patch Size(s) sf
Est. Pvt.Thickness in,
Est.Patch Unit Price$ !sf
Est.Patch Cost$
Est.Curb Replacement eft
Est.Curb Unit Price$ !ft I
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 aft or more from the property line per Total Due$
section 2.17 of the zoning regulations
( )Cash ( )Check#
Applicant is responsible for contacting the Police Dept.and C.B.Y.D i
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
WINOSOR'S 4TRFETOUTPERMIT ANUAL.
I
Signed: Print NamelQt�- G�Pri2�D Date:
Engirteering/permits/Street Excavat Permlk 2017
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