HomeMy WebLinkAboutExpose and raise CP Test Station Dart Hi 700087 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/19/07 ``' ;..
GIS ID: 25809999
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MUNIS APPLICATION# 200700922
;..` FEE: .00
�PIRATION DATE
AP PLI CA TY'.
LOCA LOC
ATION
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NAME:
YANKEE GAS
DRESS: 112 PROSPECT HILL
...:. Q I�1. FF8OUTH WINDSOR
EAST WINDSOR,CT 06B 5- 4 TT.LL; AN AVE
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NE 860-2 ..
�ITDSO CT 0 6074
92-2242
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APPL
ICANT NT
AGR
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ST OF FURNI
SH THE T�>
TH.;t�k3�4�;�4�'.' �E'BONI7 REQUIRED A.,: Q AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR H `P- .M TNTENANCE OR RE PAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE"":.PPEI NTIS;I T IT"I�>1 i,4R4: L% BIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN 0F"Sou I I '1NDSgA' :; EI'G:f;•IT PER1vII1-MANUAL.
ISSUED BY DA'1 " SPEC'IlD INSPECTED BY
6/19/2007 10:11 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 0002?7 CONTRACTOR: ai 6:�
LOCATION:_ 11I I /E? �J. ADDRESS:
TYPE OF WORK:_ X ®ate 4' �,� I S.e C' c4� � 0
DATE INSP NEEDED: DATE INSP: 2 !O
-INSPECTED BY: 6 b
WORK IN
PROGRESS:
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INPUT:_ DATE:_ "13-per
06/13/2007 ITED 49.05 FAX 243 596 3130 YANKEE GAS WATERRURY,CT
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APPLICATION FOR STREET EXCAVATION PERMIT 70w,
TOWN OF SOUTH WINDSOR Permit No.
' PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm
Address of Firm Phone No._�13 S 6 A
7.
Location of proposed work f'
Describe fully nature of permit requested_ �C ��
Starting date
Call Before You Dig No. � � j Approx. time for completion
Traffic Services Control No.
Show sketch of proposed work or famish
two copies of separate drawing Indicate North This section to be filled out by
Town of South'Windsor
Pavement Cut
No.cuts
. 0
Est.Size of Penn.Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit$
Total Due$ by
)Cash( )Check# .
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
Amt.Due Town
By
Applicant is responsible for contacting
the Police Del2t.and C.B.Y.D. Da
AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN OF SOUTH DSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WI T S PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS IN IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signe
Date:
Title:
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES