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HomeMy WebLinkAboutGas Street Cut Permits 570 Niederwerfer t ��$c� of Suutn Windsor , CT Permit No. Street Excavation Permit Date 02/10/ 1997 Expiration Date 02/ 10/ 1998 Descrip: Applicant Location Name YANk.EE GAS 0570, NIEDERWERFER RG.A Addr. P.C. BOX 339 Type cif Work, GAS ENFIELD CT 06062 Phone (860 )292-2236 Applicant agrees to furnish the own ©f South ��hdsor the amount of bond required and to reimburse ""the,"'Town` of .S�Pu,th Wi"bdsor" for any expenses incurred by the Town for maintenance Or repair work° in` connection with this permit and that applicant is familiar with and well abide by the rules and regulations for permits a$ outlined in the Town of South Windsor' s Street out Permit Manual . * PERMIT TO BE KEPT ON JbB SITE AT ALL TIMES. Title I s s u ed b y / Date Completed _.�__ �________ Inspected By ___.--_-- v APPLICATION FOR STREET EXCAVATION PERMIT / TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm //�N lC�'E S Phone No. a 2 S-2 Address of Firm C w/ivy r Q .12 Location of proposed work N /Z i�� Vv c.e .�C iC 4? Describe fully nature of permit requested E')- iQ o /�B�v/X Y f//✓� io >2 �"��c�CE X-195 sE.PvscE Starting date zw.,9 �/ /'S S' 7 Approx.time for completion Call before you dig no. Traffic Services Control No. Show sketch of proposed_work or furnish To be filled out by Town of So. Windsor two copies of separate drawing ��- Pavement Cut Indicate North Prop.size of cut 7yp,�,9 L /' Se,2T N '6 w 7-#P-0v G,� oL 1p No.cuts Amt.of Deposit$ by ��I O Cash O Check# P120,�rs-4'0 c,¢S t77-4/.v � Cut size after Perm. Patch Grp s /22,9L/N No.Cuts Final Billing$ Amt. Due Payee $ /.e A;) - a w f2 120 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: Date: Title: D.L.#i PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES