HomeMy WebLinkAboutGas Main Street Cut Permits 575 Deming S TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3634 Cont.r:ac't... YAN12E' :., pS
Location 0575 DEMING STREET Address 712 =F'RpSPECT:,_HILL RD
Type Work GAS
WIATDSRR CT `0:6088
Phone2;52 2.242
Date Insp Needed
--------- b a to Yak p s
Time Insp Needed
-------- (1M,
Inspected By
Work in Progress
74
F
Permit No. 3634 Town of South Windsor, CT
Date 11/19/2003 Street Excavation Permit
Expiration Date 11/18/2004
Descrip: INSTALL GAS SERVICE
Applicant
Lo..cat�cn
Name YANKEE GAS 0575 pEMING,$TREE,Tji
Addr. 112 PROSPECT HIL RD
E. WINDSOR CT 060s88 sTge of Work CAS ,
Phone (860)292-2242
Applicant agree
8.1. to f0tilas the Ta�vn of South Windsor;:the amount of bond
required and to rei;nb'Urse '.the To cog,:South TilzndsiP;r for "axiy 'expenses
incurred by the Towr:j:ftt Ma:t:'atgnance or repair work in pnn ptzon with this
permit and that appl'joant i:'sar� ;]xar.zy' t�k,, f will abzde by the rules and
regulations for permits as otztlined si :the To.'."z of gouth,..t7xndsor s Street
Cut Permit Manual.
* * PERMIT TO BE IRPT..ON SC9$ IT AT A 'L TTM>ES S.
Issued by -----�— A r
------ Title"
------------
Da t e Completed ---------------- Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT �34�
x TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm ®� N K h Phone No.-A 0--90 2- 22,5-8
Address of Fir (L.-D J &rCV- Jdf 11 f,p �JC, 0/G)D r-Pp C�
Location of proposed work 0 r -5- �M i A)G J'V—
Describe fully nature of permit requested ' C ,nJ � CAP
�/ C
_(JL) Q R.IK i N fr V H
Starting date Approx. time for completion
Call Before You Dig No..9,0 0 0 Traffic Services Control No.
Show sketch of proposed vpA or furnish This section to be filled out by
two copies of separate dr ing Indicate North Town of South Windsor
Pavement Cut
No.cuts
LSD
>0,11- Est.Size of Perm. Patch(s)
Est.Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Lr' , Final Billing
Q� $
H Amt. Due Payee
cam— $
CL
Amt. Due Town
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: Date:
Title: �/.,r L-D ,rc 14 Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES