HomeMy WebLinkAboutGas Street Cut Permits 19 John Fitch Bou " TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3416 Contractor YANKEE GAS
Location G019 JC1M- FITCH BLVd ' Address 112 PROSPECT HILL RD
Type Work GAS E. WINDSOR CT 06088
Phone No. (860 )292-2242
Date I nsp Needed t4 n
Time Insp Needed
Inspected By
Work in Progress
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Date �'
egselhit No. 3416 Town of South Windsor, CT
Date 10/15/2002 Street Excavation Permit
Expiration Date 10/15/2003
Descrip: EXAVATE TO CUT AND CAP GAS SERVICE
Applicant Location
Name YANKEE GAS Iv S 014 FITCH BLVD
Addr. 112 PROSPECT HILL R
E. WINDSOR CT 0608 f k GAS
Phone (860)292-2242
Applicant agrees &+F 1 Wi dsor the amount of bond
required and to rei o or any expenses
incurred by the Tow e ` rep n connection with this
permit and that app i f mi h bide by the rules and
regulations for per J014 T uth Windsor's Street
Cut Permit Manual .
k
* * PERMIT LL TIMES.
Issued by
Date Completed pected By ..�� \�^ !
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Names Firm !�} Phone No. 'J
Address of Firm U f L _ v 7
Location of proposed work {�, q �.
Describe fully nature of Pe re ue_sted = C _ L
C LI CS ` L -
Starting date -Approx.time for ompletion �� 4
Call Before You Dig No.' C t' J_;L Traffic Services Control No.
Show sketch of proposed work or furnisfn To be filled out by Town of South Windsor
two copies of separate drawing !
v Pavement Cut
Indicate North > i Prop. size of cut
No. cuts
C-*
`" Amt. of Deposit$ by
�h
Cash O Check#
Cut size after Perm. Patch
No. Cuts
y L sy r Final Billing $
Amt. Due Payee$
- Amt. Due Town$
Applicant is responsible for contacting
the Police Dept. and C.B.Y.D. by 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: (.0
Date: 0 — ,Z 0
Title:_ Y"'/ �✓ ,t, /1 D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc