HomeMy WebLinkAboutStreet Cut Permits 12 Pine Knob Drive (3) 1700229 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 11/01/2017
GIS ID: 72000012 FEE: 50.00
MUNIS APPLICATION# 201701568 EXPIRATION DATE:
APPLICANT LOCATION
NAME: EVERSOURCE ADDRESS: 12 PINE KNOB DRIVE
ADDRESS: 112 PROSPECT HILL ROAD OWNER: CUSTER SCOTT B&SALLY E
EAST WINDSOR,CT 06088 12 PINE KNOB DRIVE
SOUTH WINDSOR,CT 06074
PHONE
WORK DESCRIPTION: VAC HOLE TO EXPOSE AND RAISE PAVED OVER TEST STATION
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 WINDSOR'S STREET CUT PERMIT MANUAL.
IL. � !cl
ISSUED BY DATE INSPECTED INSPECTED BY
ll/l/20173:21PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: V CONTRACTOR:
LOCATION:- ice. nt 5 J'►
TYPE OF WORK: ` '-
DATE INSP NEEDED: DATE INSP: 11 "Allo,
INSPECTED BY: 73,�,
WORK IN
PROGRESS:
Tc
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED El YES 0 NO
AS-BUILT:
INPUT: DATE: �'l
S/molloy/forms 2014 Town of South Windsor INPSWnON 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 $50.00
Name of Firm —U fLA Phone No. ac3-aDD-C-) (
Address of Firm 1 12 ,-- CT Zip Code
Location of proposed workVAneKnob "Or
Describe fully nature of permit requested -e1LCCto al k n G r 1 U 'ice Y n I-& jo P +-t`cl'.AA e
Starting date Call Before You Dig No a d!"1 L4 CO 33cb 3
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut XI Pavement Cut ❑Curb Cut ❑Sidewalk Cut
❑ Existing Driveway,No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch.of proposed worts or fumish Indicate North This section to be filled out by Town
two copies of separate drawing
YY "Y" RGti� No.cuts
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price
n
/ Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Sidewalk Replacement sf
Est.Sidewalk Unit Price
Est.Sidewalk Cost$
Est.Traffic Hours hr
a Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
DRIVEWAYS must be 3ft or more from the property line per '' Amt.of Deposit$
section 2.17 of the zoning regulations
Total Due$
Applicant is responsible for contacting the Police Dept.and C.B.Y.D
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES ( )Cash ( )Check#
Paid By
1 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 AN REGULATIONS PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT UAL. 1
Signed: Print Name J�umo►� Date: Io `
Engineering/permits/Street Excavation Permit 2017
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The material contained on this map Title:
shall be considered proprietary to
Eversource Energy and user which is �� III.
defined os any person or entity EVE �� �
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sale, purchase, exchange, gift, or V�'�pr_) V\�J' ENERGY
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and shall not furnish or disclose it G I
'ta any{hind porky without the prior Information shown is not guano nteed and Eversource Energy assumes no responsibilittyy �t Oin11�"
written permission of Eversource Energy. Contractors are urged to call Eversource Energy for further information at 1-800-989-0900 Date: _ c _
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The material contained on this mop Title:
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shall be considered nd user ( to1� ll��
Eversource Energy and user which is (1 � � 'ow
defined as any person or entity +k
who has received the map through `„ ,1
sale, purchase, exchange, gift, or V\\JI
otherwise) shall keep o in confidence ENERGY
+ and shall not furnish or disclose it
to any third party without the prior Intormokian shown is not guaranteed and Eversource Energy assumes no responsibilittyy eji Oin�"
written permission of Eversource Energy. Contractore are urged to call Eversource Energy for further information of 1-800-989-0900 ate: — C —