HomeMy WebLinkAboutGas Street Cut Permits 150 Strong Road i
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TOWN of SOUTH WINDSOR INSPECTION REPORT
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Contractor
Permit No. 2947 YANK.EE GAS
Location t►150 STRONG ROAD Address 112 PROSPECT HILL RCS
E. WINDSOR CT 06088
Type Work GAS
Phone No. i 860 i 292-2242
Date 7nsp Needed Date
Time Insp Needed Time Insp.
Inspected By ----------
Work in Progress __ - - - — - --- --- -
Input 0at,e __ 1
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Permit No. 947 town cif Soutn Windsor, CT
Date 04 ` 12f2000 Street Excavation Permit
Expi r a:;ion Date 04/ 12/2001
Descr ip : EXCAVATE TO INSTALL GAS SERVICE
Applicant Location
Name YANi�Et GAS0150 STRONG ROAD �
Addr . 112 PROSPECT HILL RU
E. WINDSOR CT 06088 i ype of Work GAS
Phone ( 860 )292-2442
Applicant agrees to furnish the 'Town of South Windsor the amount of bond
required and to r eimburse tine ' To wrt of Shutt-} Windscr- for any expenses
incurred by the Town for mai nter►ance or repair worK 'in connection wi r.rr this
oerriifi and that app I icant is taint .l 'iar witch and will abide by i;he rules at"
d
regulations for pe r rn,t.s as oukt l i ned in the Town of South Windsor ' s 5tr eet
Cut Permit Manual .
< PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES.Title
Issued Ov
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 $25.00
Name of Firm a c
Address of Firm_ I Phone No. 9 - 7-2 5.7
Location.of proposed work ," oc
Describe fully nature of perm request
Starting ate
Approx.time for completion Call Before You Dig No. Z o 0 o /G o� q
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing To in filled out hy Town of South Wind r
Indicate North Pavemen C��
Prop.size of cut
15 QS No.cuts
Amt.of Deposit$ - by
I
OCash OCheck
# .
Cut size.after Perm. Patch
No. Cuts
wa rk (a-e Q - Final Billing$
Amt. Due Payee$. .
Amt. Due Town$
_ Applicant is responsible for contacting \
the Police Dent-and C.B.Y.D. �p c 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 TH
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. E
Signed`
- / Date:
Titl D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc