HomeMy WebLinkAboutStreet Cut Permits 50 Beldon Road (2) 1800115 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 08/21/2018
GIS ID: 09300050 FEE: 50.00
MUNIS APPLICATION# 201801472 EXPIRATION DATE:
APPLICANT LOCATION
NAME: EVERSOURCE ADDRESS- 50 BELDON ROAD
ADDRESS: 112 PROSPECT HILL ROAD OWNER: WILLAI?SEN MICHAEL L&BETH A
50 BELDON ROAD
EAST WINDSOR,CT 06088
PHONE
WORK DESCRIPTION: INSTALL GAS SPRVICE`W/0 SE821307
APPLICANT AGREES TO FURNISH 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 THE'APPLICANT IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINI)SOR S STREET CUT PERMITMANUAL.
ISSUED BY D TE INSPECTED INSPECTED BY
8/2 1/201 8 2:49PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 00// CONTRACTOR: �' �1 P�'�Sd U rl p
LOCATION: s-o 9i I deoY ll ,�Da
TYPE OF WORK: ►n_� ,� ,,,.!�.�
DATE INSP NEEDED: DATE INSP: i/1 -7 (l y
INSPECTED
WOM I111
PROGRESS:_ i w=> ��- -� E w eI Ll,
7 "
L ti�t,?n� I �t'tL tact
SEPTIC TANK PUMP®, SMASHED, FILLED ' wrmESSED ❑YES El NO
AS-BUILT:
INPUT: DATE:
S/m6nwiforms M14 Torm of South Wigs VVSWTMN MOU 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 $50.00
Name of Firm -Fn Phone No.
a-
Address of Firm D - I Zip Code 00199
Location of proposed work n
Describe fully nature of permit requested 1 Q, V .
Starting date _(bd) Call Before You Dig No aQ1 gas 0 4n 1 (o
taxes' ge M 130-1
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES-IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑Well Sewage Service: ❑ Public Sewer ❑Septic
Show sketch of proposed work or furnish . Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
t
Est. Patch Size(s) sf
i
Est. Pvt.Thickness in.
i
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Sidewalk Replacement sf
i
Est.Sidewalk Unit Price$ /sf
Est.Sidewalk Cost$
t Est.Traffic Hours hr
Est.Traffic Unit Cost$ Ittr
Est.Traffic Control$
I Amt.of Deposit$
i
DRIVEWAYS must be 3ft 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
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. `y� �a
Signed: Print Name C (�Q I Date:
Engineering/p r�jts/str;lt
Excavation Permit 2017