HomeMy WebLinkAboutStreet Cut Permits 152 Edgewood Drive 1700234 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 11/27/2017
GIS ID:29400152 FEE: 50.00
MUNIS APPLICATION# 201701679 EXPIRATION DATE:
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APPLICANT N y LOCATION
NAME; EVERSOURCE ADDRESS 1S2 EDiEWOOD DRIVE
ADDRESS: 112 PROSPECT HILI1 ROAD a .! OWNER COSTAzItUI&AMY
EAST WINDSOR,C 408s 152`EEWOOD DRIVE
S01JTH-WINDSOR.CT 06074
PHONE
4 t WORK DESCRIPTION: GASI
APPLICANT AGREES TO FURNISH THEWOV.NI OF SOUT�I WINDSOiI TIC AMOUI`1T01~BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY3s PE1SE5 INCrRRED BY TIC TOWI*T'FOR-MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TIE APP. ULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S=STREET Gi IT P:.E2MIT MANUAL.
ISSUED BY DATE'`I1VSI' CTED INSPECTED BY
11/27/20I72:18PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: V1 nth,)3LI CONTRACTOR: ' P(e5na►�C. _
LOCATION: 1-�7 a S'_J a rU,)06d
TYPE OF WORK: U }
DATE INSP NEEDED: DATE INSP: 3 o if�
INSPECTED BY: bA
WORK IN
PROGRESS;
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES El NO
AS-BUILT: '
INPUT: G,`N--- DATE:..
S/mo!!oy/forms 2014 Town of South Windsor INPSECTION REPORT 14
. AFFLIUATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WQRKS DEPARTMENT
1540 SULLIVAN AVENUE Date:t
SOUTH WINDSOR,CT 06074
FEE V2M. 5--0.0 C2
Name of Firm fax SG uezz ' Phone No.
Address of Firm i L Zip Code
Location of proposed work_,'
Describe fully nature of permit requested _ er-., _5,yZL/Icr (LuL,f cL,,xfioT"
Starting date =Approx.time for completion
Call Before You Dig No. Existing Water Supply: [I Public Water ❑Well
Existing Sewage Service: []Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH ANI)CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL RNAL 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"EAR OF THE TEMPORARY PATCH Bur IT COULD BE LATER THAN A YEAR.
Show sketch ot'proposed work or furnish Th1s saWono bg filledti
two copies of separate-drawing Indicate.North Town.of South Windsor
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$_— /it
Est.Curb Cost
Est,Traffic Unit Cost$ /hr
Est Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash O Check#
Applicant.is responsible for contacting Paid By
the Polics.De t.and C.B.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 6Y THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL.ABIDE BY THE RU.LES.AND REGULATIONS FOR
PERMITS OUTLINED 10 TH TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL,
Signed Date: l
Title Gs�J 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 Ekcavation Permit 08 REV 10.22-08
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The material contained on this map Title:
shall be considered proprietary to
Eversource Energy and user(which is
sole,defined purchase,
any person orrpegntity g - - --�r�-� EVE RS=U RCE
who hog received the ma throw h Information shown is not guaranteed and Eversource Energy "
sole, urehase,exchange, ift, or 9 9Y
otherwise)shall keep it in confidence assumes no responsibility. Contractors are urged to call
and shall not furnish or disclose it Eversource Energy for further information at 1-800-989-0900 ENERGY
to any third party without the prior
wnite,i permission of Eversouce Energy, Plotted:06-Nov-2017 I By:gisewrl