HomeMy WebLinkAboutGas Main Street Cut Permits Bailey Circl Permit No. 3734 Town of South Windsor, CT
N Date 05/27/2004 Street Excavation Permit
Expiration Date 05/27/2005
TO FED "NEW DEVEZ011.. EbTT CALLED SHADY BROOK
Descrip: INSTALL NEW GAS MAIN
" LaCA-ion
Applicant
Name YANKEE GASH1DS° HFtO4K SRD
Addr. 112 PROSPECT HILL RD
E. WINDSOR CT 06088: TMpeE-Work GAS
Phone (860)292-2242
Applicant agreed tt� furnish the South Wlnrstsr the amount of bond
required and to reimburse the. Town of qQ tli :.I or for any expenses
incurred by the Town -f6r mainCenatte. sad re�asr :work n �onnactign with this
rules and
permit and that applicant is familiar wit::h ad_kz�ll abade: by the
regulations for permi.ta: ouined n h� 70"Wn ° South Wzndsesr's Street
la
Cut Permit Manual.
* * PERMIT TO BE:KEPT qN J S BIT .'AT AL3 _.,TiMES;:'*
Issued by xit�e, -------------
Date Completed ----
TOWN OF SOUTH WINDSOR INSPECTION REPORT
r e
3734 {y i,� Contractor YANKEE GAS
Permit No. dy` Address 112 FRQSPEC€.HILL RD
Location SHADY BROOK SRD WIjSOTt CT 06088
Type Work GAS Fhone.'a�o {8 _Q)29 242
Date Insp Needed -------------
Time TnagG '_j`t
Time Insp Needed
Inspected By -------- -
Work in Progress
1 .."i
---------------------- 1
Date __-L)_ -®--
APPLICATION FOR STREET EXCAVATION PERMIT -
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm_ I.IN'KO-L &A-S Phone No. a 1�-L27
Address of Firm J Q PR0 5Pwr H IU, Rn, EA-5T ivI.MDSoR 0 66 8 P
Location of proposed work 151 S T R,,)NG- Rm-D N E/�R L A V Art-L ()U R H 60 D--iL
Describe fully nature of permit requested l V5'rhLl, NC-V (77r5 Mhl,v T a FCCP NEW AEvEIaPm -Ni
Starting date 710 fi Approx. time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or fumish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
r No.cuts
IV E�N L�EV ELDP1�1�tJT C�kLL�D (D Est.Size of Perm. Patch(s)
`SHhDY L' a--K
Est. Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$
PRO P05ED
Total Due$ by
( )Cash( )Check#
'7
Permanent Patch
No. Cuts
t N K°it1> Size of Patch(s)
Final Billing
v
$
Amt. Due Payee
LA�IkLL�I y $
1)( iZ Amt. Due Town
CIE $
By
Applicant is responsible for contacting 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:_ � � ��y ,��r Date:
v
Title: 1<)'&R kT(oP6 Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES