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HomeMy WebLinkAboutGas Main Street Cut Permits 462 Avery St • Permit No. 3479 Date 05/05/2003 Town of South Windsor, CT Street Excavation Permit Expiration Date 05/04/2004 Descrip: INSTALL GAS SERVICE ACR©SS 'STRFET (3IOUSE Applicant Location. Name YANKEE GAS Addr. 112 PROSPECT HILL RD 0462 AVERX STREk1 ':. E. WINDSOR CT 064$8. Phone (860)292-2242 TYPe af`Work CxAS Applicant agrees to 'fur3s.h the-::::Town o SOtxh Windsor the am qunt of bond required and to reimburse the. Towx o€ SoutY� dsax.for any expenses incurred by the Town.for maintenance or nepair work 'i permit and that app n Gonnecti:bn with this licant is €amslz;ar w �i anal W1.11 'abide by the rules and regulations for permits as outlined; in tT: Trswri o€ South Windsor s Street Cut Permit Manual. * * PERMIT TO BE...KEPT"ON JOB SITE AT ALL TIMES. Issued by ��A ---------—---- Ta tl e _ r --------- Date Completed v ......... —...... Inspected By '��__ •�� �� t TOWN OF SOUTH WINDSOR INSP ECTION REPORT Permit No. 3479 CGC ��:��o., �„ - die ��� Contractor YANKEE .GAS Location 0462 AVERY STREET Address T12 PROSPECT HILL RD Type Work GAS WINDSOR CT 06`0:88 Phone No (&6(��292 2242. Date Insp Needed ------------- — Vat Insx Time Insp Needed ------------ .1me Ixzsp Inspected By Work in Progress ----A��� ------------ ------------------------ ----------- Input , Date-�--- ., 41479 APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm N k . (3 Phone No. Address of Fi 0 C W Location of proposed work De ribe full nat re of permit"Aed . Starting date Approx.time for completion Call Before You Dig No. Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town of South Windsor two copies of separate drawing Pavement Cut Indicate North Prop.size of cut No.cuts Amt.of Deposit$ by . L L fC43 a Cash O Check# JA r/ h Cut size after Perm. Patch SL C- No. Cuts Final Billing$ Amt. Due Payee$ Amt. Due Town$ Applicant is responsible for contacting by _ date the Police Dept.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 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: Date: �� D l' 0 3 Title• V" / c �xc-A D.L.#: PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES Standard Forms\Permits\Street Excavation Permit.doc