HomeMy WebLinkAboutExcavate to mole road to install 1/2 pla 800137 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/05/08 '
GIS ID:26700088
FEE:
I?�RATION DATE:
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MUNIS APPLI CATIO N# 2008011
98
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08/05/09
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APPLICANT
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NAME: YANKEE .... ;•:..:::.:...:.... ,,,
GAS k:h ..,y„y.�>,t.. ..r<
.: ?RE'�`� .'A�>�8$„DEBBI:E DRIVE
ADDRESS: 112 PROSPECT H '<>< ,.,.:: ""
ILL R�`D C ( ER E T S6N ROBERT J&RACHELE E
EAST WINDSOR,C llE7I8$ ,, 8, .,., EBBE DRIVE
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OTTH WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: EXC YT& VOLE� �' Z H:PIV� AS GAS SERVIC
E
APPLICANT AGREES TO FURNISHv<>=<<'«x<:• v<'` `:.::r
THE fJ "iDF" QUT ,A� 6J1,'F:B. ND REQUIRED
Q AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANI�,EXPEI3nINTFm MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THEW PRL t.N i 1 > Al I 'V�TIC:; 1ND WAL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S Q:UTf k��Ni�?'Si i STI E r'� 1tMIT MANUAL.
ISSUED BY ��:_.•��<.:..,. °�'
DATE INSPECTED INSPECTED BY
8/5/20083:26PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:_ &Q 13 7 CONTRACTOR:_ q S
LOCATION: SY
TYPE OF WORK: �'X CCtyci�P f`j V�V� �r'�']r� -Vzp 11 slA)�
DATE INSP NEEDED: DATE INSP: `��/r l a f
INSPECTED BY: 159
WORK IN
PROGRESS:
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AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE
Name of Firm Gi j4j Phone No.,d?6 0 '-o�/ •2
Address of Firm 0 ly Fir L I� � W
Location of proposed work ,
Desk 'be fully nature of permit requested vto M p L D I
Starting date =f�— b S Approx.time for completion a
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North J Prop. size of cut
,r R
b No.cuts
00 — - - - - Amt.of Deposit$ by
O Cash O Check#
® � Cut size after Perm. Patch
y No. Cuts
Final Billing $
ti
Y Amt. Due Payee$
r� 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: 0409�_ �j -Q � Date: q"
Title: Qom/ Ly C/ D.L.#:
PERMIT-SHALL-BE-KEP-T_ON-10BSrrE-AT -ALLMMES - - -
Standard Forms\Permits`Street Excavation Permit.doc
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