HomeMy WebLinkAboutRepair gas leak at 12 Pine Knob and Aver 700028 TOWN OF SOUTH WINDSOR, CT
r PERMIT NUMBER STREET CUT PERMIT
DATE: 04/18/07 s:"...... a
GIS ID: 72000012
`. FEE: 00
MUNIS APPLICATION# 200700464 „ y
s E 'IRATION DATE: 04/17/08
APPL I CA
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NT
kj OCA ON
NAME
YANKS E GAS
DRESS`':::'; IZ<PI �KNOB DRIVE
ADDRESS: 112 X" ; Gf, .::.....::...::.
PROSPECT HILL RD :;.,... a '` <` :° ;'.:;.'«<,':'.:
�'..�..a �T�R S�OTT B&SALLY E
EAST WINDSOR,CT t6
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,. "P��KlVOB DR
IVE
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860 292-2242
SO CT 06074PHONE
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SCRIPTION:
SCRIP TI ON: REP "GAY.
>27.APPLICANT AGREES TO FURNISH THE TOWN 0 .: •L7JIH 13 '! �[� F DOND REUIRED AND TO REIMBURSE
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THE TOWN OF SOUTH WINDSOR FOR AN T E ENS ING ? FI)£ T0�vCrP' ,M'A'TN' TENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THh;:Xfi, cXi-�`T§;F!' 4b WIi 1 ,ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OI (V 1'I>WT °.5 Rl* T1T:•,,,pRTI ANUAL.
UED BY DATE<'INPC`PED INSPECTED BY
4/18/20072:17PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 70®oa F CONTRACTOR: "Y a,tee `S
LOCATION: /c) P11� k��� ADDRESS:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: A
INSPECTED BY: ra
WORK IN
PROGRESS:_
INPUT: C/W— DATE:_ �. —�
APPLICATION FOR STREET EXCAVATION PERMIT 100011
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm_Zh N k kl- Cv h 9Phone NoI§ 6 a
Address of Firm_ / 2 S � _v 14 (�
Location of proposed work 12- N
Describe fully nature of permit requested Xc 16 V" r�
Starting date_ -- 3
Call Before You Dig No. ���)/'3 Q . Ss" Approx. time for completion
Traffic Services Control No.
Show sketch of proposed work or famish
two copies of separate drawing Indicate North This section to be tilled out by
Town of South'W;ndsor
Pavement Cut
No.cuts
Est.*Size of Penn.Patch(s)
Est Pvt.Thickness in.
Est Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch _
No. Cuts
Size of Patch(s)
Final BiOing
Amt Due Payee
S
Amt.Due Town_
. By
Applicant is responsible for contacting
the Police De t and C.B.Y.D. Date
-
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:
/'0
Date:_ —/,Y
Tide:_
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES