HomeMy WebLinkAboutGas Main Street Cut Permits 343 Deming S TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 3576 Contractor YANKEE" GZ-),S
Location 0343 DEMING STREET AddYess 112 PE:C7SPECT<;,HILL RD
Type Work GAS E WINDSbI2 T >6088
Phone No. (860)292=2242:;
Date Insp Needed Date Insp �^
Time Insp Needed
Timex�Sp
Inspected By Jicrrt�e
Work in Progress
Input ,U� Date
Permit No. 3576 Town of South Windsor, CT
Date 08/28/2003
Street Excavation Permit
Expiration Date 08/27/2004
Descrip: NO RD CUT
Applicant Locat%'on
Name YANKEE GAS 0 343 DEMING S:TRF,,ET
Addr. 112 PROSPECT HFLL;:RD
E. WINDSOR CT '064$8 T?pe of.>t«Fork GAS
Phone (860)292-2242i
Applicant agrees to furnisk the Tows b,f Sts�zth Windsor tihe ,amQunt of bond
required and to reimburse the: ToYzza #3 South �bdspr Apr any> expenses
d.
incurred by the To:: nd'e or 'repair work i,u eonn.ectaon with this
permit and that applie'ant is:fmi2r wst}§ end "will abide; by the rules and
regulations for permits as puti�ined.a n the �owxf'of South 4V, nd`sor's Street
Cut Permit Manual.
* * PERMIT TO BE KE PT ON SOE .:SITE'AT ALL TIMES.
Issued by ----
Date Completed Inspected B
• 2-5-
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm �
Phone No. ' �� �
Address of Firm (Lo - X=
Location of proposed work 3 Q rA4 I f►�—
Describe fully nature of permit requested X,
S' /9 11 G c
Starting date 0 q— — Approx.time for completion
Call Before You Dig No. _D 0.33 S' :L(? % Traffic Services Control No.
Show sketch of proposed work or furnish To be filled Out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop. size of cut
343 No. cuts
._j Amt. of Deposit$ by
0� �'7
Cash ( )Check#
Po, V)
Cut size after Perm. Patch
a
No. Cuts
Final Billing $
Amt. Due Payee$
C+L, (� 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:_ r� 4 Date: C� o, _ (7
Title: r^1 1) C.14 D.L.#:
PERMIT SHALL BE KEPT ON)OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc