HomeMy WebLinkAboutGas Street Cut Permits 388 Pleasant Vall TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3427 Location Contractor YANKEE GAS Type Work GAS Address 112 PROSPECT HILL RD
E. WINDSOR CT 06088
No. (860)292-2242
Date Insp Needed
Time Insp Needed .
Inspected By
Work in Progress ,1?
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SOR - G
J Date
It No. 3427 Town of South Windsor, CT
te' , 11/04/2002 Street Excavation Permit
Expiration Date 11/04/2003
Descrip: INSTALL GAS SERVICE TO HOUS
Applicant 0 S Location
Name YANKEE GAS:.
AS ` L ANT V LLEY
Addr. 112 PROSPECT HILL
E. WINDSOR CT 06 GA
Phone (860)292-2242
Applicant agrees to t Zn soir the amount f bond
required and to rei T uth o� any pens
incurred by the Tow ten epa k n �� onne ion th. s
permit and that appli n a bi! a by the rules and
regulations for perm t ou7%p *VIgdgsor's Street
Cut Permit Manual .
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* * PERMIT a4LL TIDES *
Issued by 5• so CV1 e
Date Completed Inspect6ipBy
1
�4LI-7
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm rj f� p si 1� Phone No. / 9 2-
Address of Firni I a f Vr,,F C- N : v
Location of proposed work k v
Describe fully nature of permit requested x C` �T O I Ai y-y)It O J' 2 � ( C
L� ci2k ra; Ir ZIV) -� tl k 'l
Starting date Approx.time for completion
Call Before You Dig No.;Z C C. ')- Ct ,L S Z ` Traffic Services Control No.
Show sketch of proposed work umish To be filled out by Town of South Windsor
two copies of separate drawing
_Pavement Cut
Indicate North Prop. size of cut
ass No. cuts
Amt. of Deposit$ by
( )Cash ( )Check#
Cut size after Perm. Patch
No. Cuts
�.,
Final Billing $
Amt. Due Payee$
G �� G,L• 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: f -Q'0— M Date: Z—
Title: f( k L Cl D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
c Nn TOWN OF SbUTH WINDS
OR,
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m ht eq: ft%UC WORDS DEPAR`I1KENT
Date
- TOWN HALL
t It on File 1540-;SULLIVAN AVENUE Permit No.
SOUTI4 1WINDSOR, CT 06074
Date of Expiration Permit Expires ,
APPLICAT-ION FOR PERMIT
FEE
Name and addres s of applicant Phone No:-2 92 4 ,
Location of prdpbsed work
Describe full nature of ermit r
Y P equested ,)< /✓
Insurance on file with Town yes no Date policy expires
Name of Insurer A .CQ i5 �-
oApproximate time for mpletion 1 Z- � _ yzDesired startingate
Call before you di ticket YJo.- Z5"'U
�a Y 9 �
Show sketch of proposed work or furnish 2 copies of separate drawings
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Al.'1
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QApplicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
I agree to furnish to the Town of South Windsor the amount of bond or deposit re4ui4ed qnd 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 rues and
regulations for permits• as outlined in the Town of South Windsor's (Pavement Cut .Religlati6hi.)
Signed
APPROVED: DATE APPROVED: 11 DATE Z
Supt. of Highways pA.'7 Town Engineer
j
Date completed
FOR INSPECTOR: Date work star fed
- y.;
u ficie"nY noti cation'received: yeas no Type of reir�_
-- - -
Unusual conditions encountered
Material slips attadhed: yes no Datea for Perrhanento repair
Signed