HomeMy WebLinkAboutStreet Cut Permits 685 Governors highway (5) 1500150 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 07/20/2015
GIS ID: 36900685 t u FEE: 0,00
MUNIS APPLICATION# 201500949 EXPIRATION DATE:
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Tk y y APPLICAN 5 LOCATION
NAME: EVERSOURCE ; ADIRES3 .' b _IOV RNORS HIGHWAY
ADDRESS: 112 PROSPECT HILL GWNER MIDFOIGIL R&DEBORAH C
EAST WINDSOR,CT 06088 �iBYO RNORS HIGHW
SQITH VINDSOR CT 06074
PHONE 860-292-2242
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WORK DESCRIPTION: EXCtVhAfi,TOvIOE SAS SRYICE �. �"ti �
APPLICANT AGREES TO FURNISH T REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FO TENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT IDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED INTHrE/TOWN OFfSOT H WINDSOR' STREET CUT.PRIT MANUAL.
ISSUED BY INSPECTED BY
7/20/2015 3:20 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO;: l 'i90 z 512 CONTRACTOR:_f' 1/L°� (V U C, e
LOCATION: -
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: I0L�Zg r
INSPECTED BY: gs-)
WORK IN
PROGRESS: T ��
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSECnON REPORT 14
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Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $26.00 BE-5 7-0 6
Name of Firm Phone Na. �g
Address of Firm ! 9, 1P f—o Zip Code b
Location of proposed work big 5�i/ o C)
Describe fully nature of permit requested
Starting date0 Approx.time for completion
Call Before You Dig No. `2�$b 2 0 ( Existing Water Supply: Public Water ❑WeEI
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&YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch bf proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town.of.South Windsor
0 n4 u� No.cuts
W�1
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est. Patch Unit Price$ /s€
�'—&P6 Est.Patch Cost
Est. Curb Replacement ft
00,
Est.Curb Unit Price$ A
M � � Est.Curb Cost$
Est,Traffic Unit Cost$ fir
Est:Traffic Control$
Amt.of Deposit h
Total Due$
{ )Cash { )Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.R.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: d J
Tiitle:. ( 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
Street Excavation Permit 08 REV 10-22-M
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