HomeMy WebLinkAboutStreet Cut Permit 206 Buckland Road 800123 TOWN OF SOUTH
PERMIT NUMBER H W I N D S O R, C T
STREET CUT PERMIT
DATE: 07/28/08
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GIS ID: 15300206
MUNIS APPLICATION# '. ' '`f `":200801139 % :f : " FEE: .00
EXPIRATION DATE:
j 07/28/09
A PPLICA
NAME: YANKEEGAS
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%LOCA TION
ADDRESS: 112 PROSPECT HILL n 2Q6 BITCILAND ROAD
EAST WINDSOR C 4 ;`:.: ';dR ( II�7SVILLE MARRION&ROY
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;., RL71VI1}IN ROAD
PHONE g
60-292-2242
WORK DESCRIPTION: INST1 �� E gfi AII3 ROAD
a � t O r
APPLICANT AGREE `£
S TO FURNISH THE TOW#XPEN. 3ZJTI REQUIRED AND TO REIMBURSE
EXPIIJ
THE TOWN OF SOUTH WINDSOR FOR ANY IN ' ,
CONNECTION WITH THIS PERMIT AND THE T ? I I T`I ;F I .:W TH,, I) I L ABIDE BY THE RULES AND
..., dW < 01 .<IV�AINTENANCE OR REPAIR WORK IN
FOR PERMITS AS OUTCLINED IN THEATO{��jWN�OF S(3I.1T'4',rI SR',STR ?E I.C 1I pE IT MANUAL. REGULATIONS
ISSUED BY � ` " '-�
DATE INSPECTED INSPECTED BY
7/28/20089:32AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR
ENGINEERING DEPARTMENT
ADDRESS
PERMIT NO. SHEET
UTILITIES OF
INSPECTOR TEMP.PATCH DATE
INSPECTOR COMPLETION DATE
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: o CONTRACTOR:_ i�G"i y1
LOCATION:
TYPE OF WORK: 1 0 SfiCA
DATE INSP NEEDED: DATE INSP: ! rt'/o 9
INSPECTED BY: >
WORK IN
PROGRESS:_ C
AS-BUILT:
INPUT:_ DATE:__ v (�
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION. PERMIT F
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm "1v�l;�t' ��� `�t✓l;Ui(,tS
Phone No. y,� �� 1 I
Address of Firm 1 I r h���c Li H 1 LL, ?f ? ►��i> �� LT r)OP'R,
Location of proposed work �n 6 / a },;;�h.L� ,, }\�� �� l\ i ✓n i\
Describe fully nature of permit requested_ j� --Y'
Starting date A-) �Pt(I���� .�.,
Call Before You Dig No.�;�o� c, , ;7�� Approx. time for completion
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing �, Indicate North This section to be filled out by
��rh t i n�' }` Town of South'wndsor
Pavement Cut
No.cuts
Est.'Size of Perm.Patch(s)
1_
Est.Pvt.Thickness in.
Est.Unit Price$
(�l L!c�(1� ,k1 Amt.of Deposit$
Total Due$ by
Cash( )Check#
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
Amt.Due Town
. By
Applicant is responsible for contacting
the Police Dept.and C.B.Y.D. Date
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 A131DE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
Date:
Title: Drivers License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES