HomeMy WebLinkAboutStreet Cut Permits 9999 Evergreen Lane 1900040 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 05/03/2019
GIS ID:31209999 z FEE: 50.00
MUNIS APPLICATION# 201900828 ?s` EXPIRATION DATE: 05/02/2020
S f ?r1 i ix E
APPLICAN}Y v _ LOCATION
NAME: EVERSOURCE 1' ADDRESS EVERGREEN LANE
ADDRESS: 112 PROSPECT HIL11 Rf�A Ofr NER 1 OWN F SOUTH WINDSOR
rT, 40§[bMVAN AVE
h
EAST WINDSOR,CT.06088.
PHONE q �I
WORK DESCRIPTION: EXA VsATO INSTALL GAS MAIN AND�9IVIOE k
r w,s Y
APPLICANT AGREES TO FURNISH THE,.TOft. pF SOI 'I I#WINDS(? THE l�MO]IVT OF B+DND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN &—XP NSES INCURRED,BY THi TO FORIfVIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND T QP�I.ICr� . I5 FA�IIJIAR VC�ITr , D Vy!TLL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN,F S�0?UTH WINDSOR'..S STREET BUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
5/3/2019 10:34 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
fv
•,; l Yi
� 7 1
w „l
4V
4r j
I3 i A � r r•. 4 i
(1 'E t
sY
oi
}
t
C
r
r
f
T 1NM OF SC�U'�'N.WINDSORINSPECIWN RE PORT
.. PERMIT No.; .
LOCATION:
TYPE OF UVQRK: �
vi ,
EE
DATE INSP DATE INSP:. �G�i 71
INSPECTED BY:,
WORK---'.IN
PROGRESS.
CawLv� f h
SEPTIC TANK PUMPEp,SMASHED; FLIED
luVrMESSED ❑YES El NO-
AS-BUILT:
DATE:
S/moilogRoms 2014 Town of Soak+Wiitd5or•]P1P5 N IMPORT 14
�w w a..iv� • ew.iwt ■ vw� v w w ww.�w... � w�iwiti>, ■ •■ ....•. . ._..,... .
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074 FFE�E_$50.00
Name of Firma Phone No. �P(�' "� r _-
Address of Firm 11 ,Q VCQ ZipCode Q (�
Location of proposed work AMA L1�
Describe fully nature of permit requested U SVC,■
Starting date Call Before You Dig No C&T- 1,-d»,3i%It
I
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES-IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: I No Pavement,Curb or Sidewalk Cut pavement Cut ❑ Curb Cut ❑Sidewalk Cut
I
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑Well Sewage Service: ❑ Public Sewer ❑Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
0 No.cuts
Est. Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /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
Est.Sidewalk Cost
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
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 80ND 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
WINDSOBAP ST T PERMIT MANUAL. /�
Signed. Print Name 1 r0 oc Date: G
Engineering/p rmlts/Str t Excavation Ferma 4VJ..