HomeMy WebLinkAboutGas Main Street Cut Permits Dogwood Lanef _
TOWN OF SOUTH WIND60R INSPECTION REPORT
Permit No. 2931 Contractor YANKEE GAS
Location INT .W/ PAM LN. Address 112 PROSPECT HILL RD
Type Work GAS E . WINDSOR CT 06088
Phone No. ( 860 )292-2242
Date Insp Needed Date
Time Insp Needed — Time Insp.
Inspected By _
Work in Progress
Input — - Date
Permit No. 2931 ;-own of South Windsor, CT
Date 0"/24/2000 Street Excavation Permit
Expiration Date 03/24/2001
Descrip: REPAIR GAS LEAK INTERSECTION OF DOGWOOD & PAM
Applicant Location
Name YANKEE GAS INT.W/ PAM LN.
Addr. 112 PROSPECT HILL. RD
E . WINDSOR CT 06088 Type of Work GAS
Phone (.860 )292-2242
Applicant agrees to furnish .the Town of South WOndsor the amount of bond
required and to reirnbur•se the. Town ofSouth Windsor . for any expenses
incurred by the Town for maintenance or repair work in connection with this
permit and that applicant is 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 .
* PERMIT TO BE KEPT 'ON JOB `SITE AT ALL TIMES .
4..
Issued b _ Title - - -- - � - =--- -- -
Date Completed Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm n GCX5 Phone No.— ga t.0 ��a -a y a
Address of Firm C I OL
Location of proposed work S Cr. a CcKbClt, Q r►-\
Describe fully nature of permit requested R— CS e0.l
Starting date zGO Approx.time for completion
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
Cash O Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
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: Date:3�`Obc�
Title:— D.L.#•
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit,doc