HomeMy WebLinkAboutGas Street Cut Permits 495 Pleasant Vall s
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3839
Location 0495 PLEASANT VALLEY Contractq XAJE GAS
Type Work GAS Ad L ss �112 ,PROS $<C� HILL RD
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Permit No. 3839 Town of South Windsor, CT
Date 09/01/2004 Street Excavation Permit
Expiration Date 09/01/2005 '
Descrip:
Applicant
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Name YANKEE GAS
0 >� PLEASAN'1';,,�/ALZ`i;El"'
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Addr. 112 PROSPECT HI1;.,L R-D r;
E. WINDSOR CT ObO: .$' ��' f
Phone 860 292- k :'•2242
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Applicant
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rees,:
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'f u>t >t`h
�.,=�. Wind�''x�`: �1ei ani
,a" > . ::. 9...,> o.nt of bond
required and to refit ` e.._..''"''s 4 S „L: a:` of >` hr.,.f ' ; uses
incurred b the Town: g: .;:,><r .: •.. F< ' ,.
Y ax pane or`` pair rYYc 3;i oi'nection with this
permit and that apply c r s'.f y ilq ti ;Z � b }3Y"tks'e rules and
regulations for >:;e: -:
9 permi" s as; : 't .fine` - c.'ttt S Viipdsor l s Street
Manual
Cut Permit
* * PERMIT TO"::B:$ KF",t} ....0R'*"4TQt:a.'.t IT—s':^AT.:„A'$s.'...T MES.
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Issued by
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Date Completed Inspected B
APPLICATION FOR STREET EXCAVATION PERMIT 8s?
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm Phone No. C�
Address of Firm cS
Location of proposed work
Describe fully nature of permit requested C 8 /�� I� C U P,D IJJ'V 19 rr8 j
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Starting date 9 D 7 — 2, a C> 5� Approx. time for completion 1 A y
Call Before You Dig No.�2-0 O 3 ,6 0 C 0 - 2, Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No.cuts
Est.Size of Perm. Patch(s)
ft pi 1 LL�Y �� Est. Pvt.Thickness in.
l Est. Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check#
Permanent Patch
No. Cuts
we Plzo PvS'Ffl Size of Patch(s)
t��l ���� Final Billing
Amt. Due Payee
p $Amt. Due Town
By
Applicant is responsible for contacting 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:
Title: C x'- fl C Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES