HomeMy WebLinkAboutGas Street Cut Permits 179 Hillside Driv TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No, 3729 Contractor YANK&E GAS
Location 0179 HILLSIDE DRIVE Address 112 P..ROSPECT<;.HILL RD
Type Work GAS W„INDSOR' CT 06088
Phone No. (,860)292=2242
Date Insp Needed +
Date'
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Time Insp Needed Time Insp.
Inspected By --
Work in Progress
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Input Date
I Permit No. 3729 Town of South Windsor, CT
Date 05/27/2004 Street Excavation Permit
Expiration Date 05/27/2005
Descrip: REPLACE GAS SERVICE ,TO HOUSE
Applicant L:ocat:aon
Name YANKEE GAS y179 'H LLSI;I)'E DRIVE
Addr. 112 PROSPECT HIM, RD
E. WINDSOR CT 0$Q88 'type p Wo GAS
Phone (860)292-2242
Applicant agrees t.o furTz3sh the Town?: of South WindsC .. the amount of bond
required and to reimburse the Town of South W hdsor for any ,expenses
incurred by the Town.-:for maXnten YiCe dt:repair w6rk ip connection with this
permit and that applicant is famillar with and will;;abide::by the rules and
regulations for permits as .outlihed i1r:;Che To o€ South'W.indsOr's Street
Cut Permit Manual.
* * PERMIT TO BE KEPT ON JOH Si AT ALL TIME
Issued by ---U ! �45 r Title
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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 $25.00
Name of Firm g )� Phone No. 7
Address of Firm I I A P i _5 PjU Lr H►Lk H) e,2 L
Location of proposed work_ VA Rev Lc>C�A f;M F 4,T -F1r1pI L F
ca t5' a5irk Si & op- - V1tP1A(
Describe fully nature of permit requested 5 t
Starting date AMY Approx.time for completion D o
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing N01A
V Pavement Cut
Indicate North 31V S1mk S Prop. size of cut
~ .No. cuts
s ff �,
Rare f 3
Amt. of Deposit$ by
np
a.
()Cash()Check#
Cut size after Perm. Patch
112 MNRK D DIVE-i 7 (i✓EP L� No. Cuts
'71 LAi;E ST
315 Final Billing $
�-ls 14IL.LS1AL i)ii1Vr� S ll NafiYH NUT 1EG R� '�
l79 i-iliLSt.De I)Ridj�
Amt. Due Payee$
a'� AUOLt) WA-Y(REPMR PAW*i-Y) 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: �/�' `y
Title: D.L.#:
PERMIT SHALL BE KEPT ON 3OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc