Loading...
HomeMy WebLinkAboutGas Main Street Cut Permits Avery and Wo Pe rrn i t No. Da. ter" 0411012000 Exp 1 rtt Descri '.on pate 04/1O/20fl1 down or South ° . EXCAVATE TO Street �'ir'dsor, REPAIR GAS E.<,,,ation �.EAh; INTERSECTIG�I OF Per��at Applicant Name AVERY & WOODLAN0 Addr, 1'ANKEE GAS 712 PROSPECT 6u )2 Location E* WINDSOR HILL RD Phone ( 8 CT 06058 �2-.24 Applicant Type of YJork GAS r equ i r agree;; ed avid to to turnish� the 3 nc:ur red by the 7 mbursp, tt��? Town Town of South permx It cwn South IV7nQ8()r the regu1atand that appl cot ma ntenance � So W1rtdsc�r amount Cut cons ant is fatal ?'iaror repair for anti, e� of band PeYmit ��9aor permits as " with work 7n rp penses nua7 . out7irtect and w� 17 nt�ect_1on 7n the Tow abide by the with this n °f Southrule Windsor.>s a and * PAR Street Issued by MIT T© BEkEPT aN JO8 S I iE AT ALL Date —� L Cc)Mpfeted , ttie Iiaspeci�e� �y TOWN OF SOUTH WINDSOR INSP Permil No. Location 2941 ECTIpN REPORT type Work ©AS Contractor YgNKEE p ins Address 112 PROSPECT 'hone No. E. WINOSOR CTHILt RD ate Insp Needed 1860)292_2242 06088 !me Insp Needed ate ,Insp, > 'spected By Time Ir�ip, ^k in Progress -------------------------- ..Input Date APPLICATION FOR STREET EXCAVATION PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS-DEPARTMENT TOWN HALL 1M0 SULLIVAN AVENUE SOUTH WINDSORf CT FEE $25.00 Name of Firm an Phone No. (8(01 oZ9 a-aa�f�Address of Firm. f�S _ G Location of proposed work i S 0 4 r Describe fully nature.of permit requested (ery Starting date 13 Do Approx.time.for completion Call Before You Dig No. GOD Traffic Services Control No. Show sketch of proposed work or furnish To be filled out by Town of South Windsor two copies of separate drawing Payeme�cat Indicate North Prop.size.of cut CNa.cuts"'S : _ Amt.of Deposit$ - by ISO Cash O Check# ` Cut size after Perm. Patch, No. Cuts Final Billing$ Amt.Due Payee$ Amt: Due Town$ . Applicant is responsible for contacting by the P Ace Dept,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 >l PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. FOR PERMITS AS OUTLINED IN THE Signed: ,� �il�lil b U � - C Date: Title: 3 D.L.#` PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Standard Forms\Permits\Street Excavation Permit.doc Hy, 9Z9£99 3 Y 9£99 3 E � � ,3 O A-� O ti s �' v O ` n °_ ( o - y � O � T O o� --o O --:- O 0 � O £60£99 3 £69£99 3 PROPRIETARY INFORMATION: FILE NAME SCALE THE MATERIAL CONTAINED ON THIS SCALE: 1 INCH =20 FEET MAP SHALL BE CONSIDERED PROPRIETARY DATE TO YANKEE GAS AND USER (WHICH woodland 4/10/2000 Y �ees SHALL BE DEFINED AS ANY PERSON OR ENTITY WHO HAS RECEIVED THE MAP TH90LGH SALE. PURCHASE. INFORMATION SHOWN IS NOT GUARANTEED EXCHANGE, GIFT. OR OTHERWISE) SHALL AND YANKEE GAS ASSUMES NO RESPONSIBILITY. KEEP IT IN CONFIDENCE AND SHALL CONTRACTORS ARE URGED TO CALL YANKEE GAS A Product Of Yankee NOT FURNISH OR DISCLOSE IT TO ANY Gas Services Company THIRD PARTY WITHOUT THE PRIOR FOR FURTHER INFORMATION I-600-9B9-0900 CIS System WRITTEN PERMISSION OF YANKEE GAS DRAWING NUMBER SHEET OF X � r r