HomeMy WebLinkAboutGas Street Cut Permits 99 Trumbull Lane TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No-.,. 3971
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Location Andres, 112RPEC"ToHILL RD
Type Work GA >' kIIN19S y O3 CST b'45,0 8 8
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Date Insp Needed Date i v ,
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TimeInsP Needed
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Permit No. 3971 Town of South Windsor, CT
Date 05/12/2005
»>' Street Excavation Permit
Expiration Date 05/12/2006
Descrip:
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Applicant xQC
Name YANKEE GAS TRUMBUli'�,`;:40E `
Addr. 112 PROSPECT HI-I�'' ;,y+., 3'`•E. WINDSOR CT �6 B
P
hone (860)292-2242
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Applicant agrees tor.f' x%S.j0F the I. A.?mif c3 h WincS;'a. ::thu..,,alhd'unt of bond
required and to reikb1 s4.k'.` ,4 Toy � t��tM", r f r ahy ,p nses
incurred by the Town q> i &.gt*,nan' o� pai ' cir�l�s:� gtiri ct>on with this
permit and that a 1'' adh`t i 58 l ' ":" ' 'P PP ` a.>� .`6dY:1. ..;ka�b'i•i :>bY 'tfie rules and
regulations for permits a bz'ti in r3`y:'. h�>„ o of S.o0b XiA or's Street
Cut Permit Manual. 'kf -` '` %'•
x ,t PERMIT TO`"'<$ .,^•FEP '..:x0 �''''a3A :"}:"`,.tC': + �> �N .i,''r`E•M 'S•.
Issued by �—� ----- —=—=�z` .i t e'' Y •^o Ley ---
Date Completed _----------- Inspected By
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm k,,r Phone No.- `' -� 2-- ZJr
Address of Firm tl 2- 1t-v S' P,,C_� ,�'� �� 4 C.0 ,
Location of proposed work V% '�U o
Describe fully nature of permit requested .,U C#4 Y-,�- / Al PJ- ACV-r,, Jj' 7—N.A�- yy"�„�^a.�
Starting date Approx.time for completion
Call Before You Dig No�2-- 0 Q-5"Jr-q 0 Z Z Sl-2_ Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No.cuts
D Est.Size of Perm. Patch(s)
Est.Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$
Li
Total Due$ by
Cash( )Check#
Z Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt. Due Payee
Amt.Due Town
By
Applicant is responsible for contacting Date
the Police Dept.and C.B.Y.D.
1 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.
P
Signed: Date: Z 0 S
Title: 1—f,C L D `7',!rC 0 Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES