HomeMy WebLinkAboutGas Street Cut Permits 14 Pam Lane TOWN OF SOUTH WI:NDSOR INSPECTION REPORT
Permit No. 29-40 Contractor `r'ANKE=E GAS
Location 0014 PAM LANE Address 112 EIROSPtrCT HILL_ RD
Type Work GAS E . W:INDSOR CT O61j88
Phone No-. t 86(.) 292-Z242
Date Insp Needed _ v _ . Date 'Insp.-Time Insp deeded 1 j roe Insp`. _<
Inspected By _--
Work 'in Progress -- - ------- - ----- -
Input - --- pate
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Permit No. 2930 Town Ur Sour•h Windsor . C1.
Date 03/21 /2006 Street Exc avar,ion Permit
Expiration bate 03/24/2001
Descr ip: REPAIR GAS L►E'Ai•; IN STRE-E-i IN FRONT OF PROPERTY
1
Applicant Loc,at.^i on
fi
Name YANKEE GAS 0G 14 `PAM 'LANE
Addr . 112 PROSPECT HILL. RD E . WINDSOR CT 06088 Type of Work GAS
Phone ( 860 )232-2242
Applicant agrees to turn-►sh the Town of South Windsor the amount of bones
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 applicarm is tarniijar with and will Rbide by the rules and
regulations for perm r is as ou-L*l i ned -in the Town of South Windsor ' s Street
Cut Permit Manual .
PERMIT TO BE KEPT ON JUB SITE AT ALL TIMES. �
Issued by Titl
e
e r
--------------- -------------
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 $25.00
Name of Firm Q S Phone No. �fJlo 0) �
Address of Firm fD Cf
Location of proposed work 14 M
DescribpfuilyAature of permit requested �r Q
Starting date 3 a o Approx.time for completion-
Call Before You Dig No. C) a 1 Traffic Services Control No.
i
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
i y No.cuts
Amt.of Deposit$ ,by
i )Cash O Check
Cut size after Perm. Patch
No. Cuts
Final Billing
K 4 ac�eo�. Pa nn1�� 9$' .
r. Amt.-hue payee$.
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:&"'A
b _ Date: , -oPyO U
Title: ✓V-CA-C', D.L.#•
PERMIT SHALL BE KEPT ON 70BSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation.Permit.doc