HomeMy WebLinkAboutStreet Cut Permits 12 Kelly Road 1700244 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
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DATE: 12/20/2017
GIS ID:49500012 FEE: 50.00
MUNIS APPLICATION# 20I701854 EXPIRATION DATE:
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APPLICANT ,, LOCATION
NAME: EVERSOURCE A5 e 12 KELLY ROAD
ADDRESS: 112 PROSPECT HILL LOAD OWNER '; ORKQ.;SAMUEL S JR &DANIELLE
EAST WINDSOR,GT6488 12 KELIY ROAD
SOUTH WINDSOR,CT 06074
PHONE
WORK DESCRIPTION: INSTALL GAS:SERVICE FROM PLASTIC GAS MAIN TO HOUSE
APPLICANT AGREES TO FURNISH THE(TOWN(pF 5; UT -WINDSOR THE AMOUNT-'OF 80ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AI�IY EXPENSES INCURI I3$.Y THE.TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TIDE APPLICANT ISM— Lm WITH AND WII L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN bF.50i7TII WINDSOR'S STREET CUT PETMIT MANUAL.
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ISSUED BY DATE INSPECTED INSPEC ED BY
12/20/2017 2:28 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: V CONTRACTOR:
LOCATION:_
TYPE OF WORK:
4 � o
DATE INSP NEEDED: DATE INSP: . -z
INSPECTED BY: 4!),3
WORK IN
PROGRESS: L- r, ,�� s' slitu.�, iL •
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: ` DATE:_�� � I
S/molloy/forms 2014 Town of South Windsor IRPSEMON 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 $50.00
Name of Firm L Cr Lj �' 1 tk i-�- s Phone No.. l t-)— Z- � Z- " L
Address of Firm V 6,CT- H t 1( f`) - Zip Code J
Location of proposed work E 1
Describe fully nature of permit requested C091 A PJ S <S e
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Starting date Z — Z Call Before You Dig No ?—Z) I .7.5 D D
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL.AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut Pa Pavement Cut ❑ Curb Cut ❑Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch.of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est. Patch Unit Price$ /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
y Est.Sidewalks Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
DRIVEWAYS must be aft or more from the property line per Amt.of Deposit$
section 2.17 of the zoning regulations
Total Due$
Applicant's responsible for contacting the Police Dept.and C.B.Y.D
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES ( )Cash ( )Check#
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 CONFECTION 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: Print Name 2' A-. aL -9 PjQ tltd 09 Date: 1
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Engineering/permits/Street Excavation Permit 2017
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