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HomeMy WebLinkAboutGas Street Cut Permits 78 Steep Road TOWN OF SOUTH WINDSOR INSPECTION REPORT t Permit No. 3731 Location Cozl,t actor, YANKE Type Work GAS Y( E GAGAS" Addze'ss is 112 PROSPECT >.HILL RD WINDS CIR C:T 05088 Phone,No (,$ Q}292`-22.42'' Date Insp Needed ---------- — Date Time Insp Needed if7777 ---------T T z 44 I'risp Inspected By Work in Progressa�1G��TE Input Date Permit No. 3731 Town of South Windsor, CT Date 05/27/2004 Street Excavation Permit Expiration Date 05/27/2005 Descrip: REPLACE GAS SERVICE .TO HpU.SE::: Applicant Inca .ion Name YANKEE GAS 0p 78 ;5TgE;P ROAjj Addr. 112 PROSPECT HILT, Rb- E. WINDSOR CT 06 88, W0A GAS ; Phone (860)292-2242 Applicant agrees gyp, fur xsh :-.he Towrz a ;:Sgix h Wiiidsdz thexamount of bond required and to reimburse the .Town of; South: Gdaidsor or an 'expenses incurred by the ToWn far masntien rf e qx reXti it tatark in ;connectign with this permit and that applicant;; S Familaar< with <anii td1II ablde by the rules and regulations for perm,it4� as autltned �:u. !Stytit.h Winc)'s©r's Street Cut Permit Manual. * * PERMIT TO' BE "KE'PT bN 'vTL?$ .I'rT AT'°ALL ,T2.ME5, -� 00 Issued by --- _ itle - ------ Date Completed ------------ s<peCt"ed By —. U • APPLICATION FOR STREET EXCAVATION PE TOWN OF SOUTH WINDSOR PERMIT PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Name of Firm —A5 l Address of Firm I I H I Phone No. q _ Location 16 of proposed work a vS GO V11"I GSM yt s - Describe fully nature of permit requested ( 3 sr�L sERviu? w� � a Starting .l i.5 �ERVILi Call Before You Dig No. Approx.time for completion p o Traffic Services Control No. Show sketch of proposed work or furnish two copies of separate drawing To be filled out b Town of South Windsor H014 i, .; I Pave_ me�ut Indicate North �X�STi�� �I4`osteet GA - Prop, size of cut ®�� No. cuts 1 Amt.of Deposit$ by Cjf�5 MAI O Cash O Check# 13 M N k D RI V i= Cut size after Perm. Patch 71 LA1Ct: ST✓ 79-5rar R&AD No. Cuts Al vER_S Rb1 j IS LARK�WA j." 17 HiLLSID6 DRIVE+// S 71 NORTH NUT&gS&- R© ,/ Final Billing$ 179 H ILL,5i1)g NiVi:°� / Amt. Due Payee$ a!> AF WLla inky(REflbA ARj0*kY)" Amt. Due Town$ Applicant is responsible for contacting the Police De t. and C.B.Y.D, by date I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT BY THE TOWN OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED FOR MAINTENANCE OR REPAIR WORK IN PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND MAINTENANCE OR NS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. CONNECTION WITH THIS Signed: i/ _ Date: Title: D.L.#: PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Standard Forms\Permits\Street Excavation Permit.doc