HomeMy WebLinkAboutGas Street Cut Permits 173 Hillside Driv TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3728
Location 0173 HILLSIDE DRIVE Contxa:e>t`tir"Y'AT�'TrE'E:;::..GAS
Zddres 112 PRQSPEOT.;,HILL RD
Type Work GAS
E,,., WINbSO CT Q8088
Phone f7o �$ 0.)2�2 2242
Date Insp Needed
------------ � Date Iiisp
Time Insp Needed i
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Inspected By
Work in Progress
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Permit No. 3728 Town of South Windsor, CT
Date 05/27/2004 Street Excavation Permit
Expiration Date 05/27/2005
Descrip: REPLACE GAS SERVICE
Applicant Loca'b.ion
Name YANKEE GAS D1 HTLLS�DE"DRI?Tj
Addr. 112 PROSPECT HII,I RD.: OF
E. WINDSOR CT 0S088. Tte7 ,,;Wo3C GAS
Phone (860)292-2242jj
Applicant agrees to;; fux2sh the,r:Tvlar bf gouth Win�l unt of bond
required and to reimburse the, Iown of S�tlth Windsor for any exp 'nses
incurred by the ToW.ni:.f.0ri tltaittex2an tr'repx::Liork connection with this
permit and that applicant is familrar with anci;W1 2tbi,d '>'by the rules and
regulations for permits: as ota.tlaed: azx th,e Trwn of .putk� W'inds4r's Street
Cut Permit Manual.
* * PERMIT TO. BE:: KEPT ON ;O$" �� AT ALT TIMES;,:`
Issued by Title
—__ —
Date Completed
------------- I:nsg�ct By.
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm i 5 Phone No. 9+ ` �7
Address of Firm 1 a H I L, 82 E I AM Sco A
Location of proposed work�LA fZw�S Cc>�iFrr�N — p/��7— p F In Qfo R EpLt,EM uvr
O QP OSITtr SiP& OP ocpwt-
Describe fully nature of permit requested K t I; 3. SFf'Ri, S I:Rviu2 w,
Starting date 161,10Y Approx.time for completion 1011LO
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing HOA 6
iV.Ew Pavement Cut
Indicate North LYL51ING3'y°'stet Prop. size of cut
GA5 SEW
rk
i.� No.cuts
Ron
i Amt. of Deposit$ by
G .�f ()Cash ()Check#
JCut size after Perm. Patch
112 MIRK D RIVE-i 7 t CEP No. Cuts
-71 LA)CE ST V
36S v vEB Rb M Final Billing $
�'7S HILLSIDE Bii1VE j S lI NORTH MITMEG Rip
179 H ILLSibr bRjvj J Amt. Due Payee$
a3 t� WLb WkY(�REPMR pRi0-��Y)J 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•
Title:_ t/4-L,, � _ D.L.#:
PERMIT SHALL BE KEPT ON 70BSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc