HomeMy WebLinkAboutGas Street Cut Permits 71 Hayes Road TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 395Q
Location Contractor YANK GAS
Type X Add Work `"' 112 CT HILL RD
E. R
Bh�eTo 06088
.kYf 92
Date Insp Needed
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Time Insp Needed
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Inspected By
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Wow a rk in Progress
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Permit No.
Date 3950
04/26/2005 Town of South
Expirati �x`K Street Excavatondsor, CT
i
on Date 04/26/2pp , '' on Permit
6
Descrip: y° .'>� "•a.:.
PP icant .
r71
Name
YANKEE GAS s;'• s° x:"
Addr. 112 PROSPECT
H2 $S
E. WINDS ,
OR CT
Phone (860)292-2242 s sM*'> ` "4 ' ' P@ bfW
..,E .:::k+.+ ... �.t,:!..,u,. •'Kh
Applicant ag re a`
required andthe ^Tpw.
to re m % :y: ';' Win
incurred by r ., � c am u
Permit by the Tov✓zi faaz "i14en�y"4-' �j1�s.or � y q nt of bond
and that a r £ p .xie a pnses
regulations for PPS?c,,,as.t � f,f #3inect
t l� t } k'on with this
permits a '<'M:: zaS � a
Permit Manual. s eu of r{ } e rules and
Cut £ t
Street
reet
* * PERMI £ sJ>' aZ w r
T
Issued by
Date Completed _------ �, ......... >.....,..,£M<��. L Inspected By By / /��
r�r- r'r:.�LJ�►"hIVIV` II STREET EXCAVATION PERMIT 3 s
• TOWN OF SOUTH WINDSOR Permit No. .
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00 Name of Firm .
Address of Firm \\a; '��sP Phone No.
Location of proposed work I A
Describe fully nature of permit requested
44 \ GG
Starting dated ()Pjti(, C
Call Before You Dig No. 20 `,+70 3 L f 4 0 Approx.time for completion & 1 :yu � �S
Traffic Services Control No.
Show sketch of proposed work or fumish
two copies of separate drawing Indicate North This section to be filled out by
Town of South Windsor
Pavement Cut
No.cuts
Est..Size of Penn.Patch(s)
70 � 71
Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
_.__.._ ....._.._._
Permanent Patch
_ .
No. Cuts
�I
Size of Patch(s)
Final Billing .
Amt.Due Payee
Amt.Due Town
Applicant is responsible for contacting By
the Police De t.and C.B.Y.r) Date
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: 7�� -.0
Title:_ �ti/5T-e vcr io,� /
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES