HomeMy WebLinkAboutGas Street Cut Permits 178 Hillside Driv TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 2 Cont,x 'act: YANT 'E GAS
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Location
Address 112 -.ROSPECT HILL RD
Type Work GAS WINDSOI 'CT `06,088
Phor�;e No (8, 0?29'27 2242
NO
Date Insp Needed Date
Time Insp Needed _-------- Ti I Y
Inspected By
Work in Progress � —
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In ut;,. 7 Date
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Permit No. 3722 Town of South Windsor, CT
+ Date 05/27/2004 Street Excavation Permit
Expiration Date 05/27/2005
Descrip: REPLACE GAS SERVICE TO HQUSE
Applicant LaG.atlon
Name YANKEE GAS 1}17.8 TizLLSIDE DItSVS
Addr. 112 PROSPECT HILL RTC'
E. WINDSOR CT 00;8$ e Ek; Wor1 .GAS
Phone (860)292-2242
Applicant agrees to fuP.rr `sh ,the Town.;6E South Windsr ', :Che afnount of bond
required and to re mburse .t3Ye Town o� $qu�h Windsor for �n�+ expenses
incurred by the TOWn :;;f:ox mantenaxce is 'repay wtaxk rn ctnnectip'n with this
permit and that app7 icamt as; family ar'w.sth aiid +rTi 3Y;,abide; by the rules and
regulations for permits as outlihci ,'', TC ?n an' South 'Windspr's Street
Cut Permit Manual.
* * PERMIT TO BF KEPT"`DN JQ4i�r,.AT. T
Issued by —_---
-- — —
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Date Completed ____--------_—_ Lnape.eted B __
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm W Gks Phone No. r�gA`OG 7
Address of Firm IJA PROOECr HT—L—PPAT ff 1NI bq:;, d
Location of pro osed work wS _ A®6 w�G Q
�/ r,N SkPIC Si Dt: OF- I5VjLDjk67
Describe fully nature of permit requested RuLkLt " S eel. s wl ' "
Starting date 61jJbqt Approx.time for completion l a t
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish, FYisn41))u To be filled out by Town of South Windsor
two copies of separate drawing Hom 9' 5Ti,SeAvil
Pavement Cut
Indicate North kIEW 'fa' prop. size of cut
f LP6?i f .
Iv' k No.cuts
`s
Amt. of Deposit$ by
Roo O Cash O Check#
21 STEP MAD Cut size after Perm. Patch
-1 1 5 r FP kofty No. Cuts
19 STEtP UAW Final Billing $
118141 LL51bE DRIVr,/
113 5TEFP f�pPPV/ Amt. Due Payee$
934 FOSTIC R 5i F),T, 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.
15 —
Signed: Date:IV
Title: ✓�r,� G%/kl� 7e�r r �vc D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc