HomeMy WebLinkAboutStreet Cut Permit 710 Governors Highway 800173 TOWN OF SOU'TH.WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 10/02/08
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GIS ID:36900710 ,
,h E FEE: 00
MUNISAPPLICATION# 200801543X.
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APPLIC3 OCATION
NAME: YANKEE GAS G. RNORS HIGHWAY
ADDRESS: 112 PROSPECT HIL �? OUL IS MARKO V
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EAST WINDSOR C 0 8 '-
,� � � ,.•, ,���� '� ,. �dFNORS HIGHWAY
z , ' O> rH` NDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: INST' G
APPLICANT AGREES TO FURNISH THE T� OF I,_ FJ. BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE M.P� T E �TD. LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S'bITSxC T 11MIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
10/2/20088:39AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT`NO.: CONTRACTOR: AiA 100 4-il`S
LOCATION:_3 I _ r Vi AV-
TYPE OF WORK:-
==_-=- -- DATE INSP NEEDED: DATE INSP:
INSPECTED BY: l�D
WORK IN
PROGRESS:
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AS-BUILT:
INPUT: C DATE:
W/2007 Town of South Windsor INPSECnON REpORT 07 —
10/01/2008 WED 14: 01 FAX 860 292 2202 2002/002
APPLICATION FOR STREET EXCAVATION PERMIT 8 0Ch7
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm A N C G) Phone No. .29 Z- 22A 2-
Address of Firm_112- R,c 3-PEC-t- 4I LL- R �r ►rvr L�?S�?2 C c-,a 18 Q',
Location of proposed work_910 C-7 p y E r /J O eS HL4 V
Describe fully nature of permit requested_ N S T' ELL -7�}5 S C e V i C.F-
Starting date 0 5 Approx.time for completion a q
Call Before You Dig No. c:` Q03' 00Q�77 - Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
wo copies of separate drawing Indicate North Town of South Windsor
1 �
--- Pavement Out
�( No.cuts
Est.Size of Penn.Patch(s)
Est.Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$
f Total Due$ by
Cash( j Check#
1 Permanent Patch
No. Cuts
p(2)zzl
Size of Patch(s)
L� a Final Billing
� erna�5 5 $Amt.Due Payee
Amt.Due Town
By
Applicant is responsible for contacting Date
the Police De t.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 A UTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: ,(-Lk, C�
Date:
Title: Cho)-i, -e(_,.i Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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M 10/_01/2008 _WED 14: 01 FAX 860 292 2202 12001/002
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From:. Lau-ri Cr. o-c4`
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Phone: Phone:
Pages:
Date:
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Subject: T�(Ty\! Gm - (o870 Q.
Comments:
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