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/ TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3478
Location 0520 DEMING STREET Contractor YANKEE G 'S„
Type Work GAS Address . 1 `PROSPECT 'fi:I.LL RD
E ,,WINDSOR C1 .0 88
Phone No ,;(g6t��2�,2 2242
44
Date Insp Needed
------- Date Ins2�
Time Insp Needed
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Inspected By
Work in Progress _h�—
C_ __
Input Date -
1
Permit No. 3478 Town of South Windsor, CT
Date O5/O5/2003
;,,Street Excavation Permit
Expiration Date 05/04/2004
Descrip: INSTALL GAS SERVICE: T{7 <HO[TSB
Applicant I"aacatiort.
Name YANKEE GAS 0520 DFJTNG STR38t-
Addr. 112 PROSPECT HIFL RD
E. WINDSOR CT O6Q88of Work GAS ..
Phone (860)292-2242
xx
Applicant agrees', to furszzsh tha pWzl pf . h W4ndspr the a'inoiznt of bond
required and to reirtburse @he Town of wquth j�zzadso'r .€or `any expenses
incurred by the Town ;for.;.mainfea-ance or re it work zn _c;orin..ection with this
permit and that applicant is fam 3iar. wfth acid wit,:1, abzd'e by't,Yie rules and
regulations for permits as-outlined inttk��'..Twn of:.:Sour'h;WzxYdsor's Street
Cut Permit Manual.
* * PERMIT TO BE KEPT ON JOB SITE AT AL T TI,M�S.
Issued by
___------
Date Completed _-----_—___-- Inspected By -#*j�,
3475
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm N k,,r& C Phone No. y 1 C — Sy
Address of Fir 11 2 17- f Gq- let I It f4-V
Location of proposed work
Describe fully nature of permit requested C k ,} /
(11() N C 0
Starting date -- Approx.time for completion
Call Before You Dig NoP,0 Traffic Services Control No:
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indite North Prop. size of cut
RNo. cuts
a-p Amt. of Deposit$ by
O Cash O Check#
CA Cut size after Perm. Patch
' FL :r f No. Cuts
Final Billing $
Amt. Due Payee$
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: � '�- la�a� �v-� Date: "1 - P3
Title: D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc