HomeMy WebLinkAboutStreet Cut Permit 110 Graham Road 800122 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
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DATE: 07/28/08 q E_.� A
GIS ID: 37500110
FEE: .00
MUNIS APPLICATION# 200801137
RATION DATE: 07/28/09
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APPLICANT 4 .: .. b` ,OCATION
NAME: YANKEE GAS s } AM ROAD
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ADDRESS: 112 PROSPECT HILTx k R CE E JR&KIMBERLY N
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EAST WINDSOR,C��6 8 £" y{, �C'rRAH kM ROAD
TWjNDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: RELC k �S ND CATCH BASINS
APPLICANT AGREES TO FURNISH THE T F'STH. � vI T B: REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANI � E�TTC AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE�'1'Ii L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF � RB' CJT P�FIIT MANUAL.
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ISSUED BY DAA
INSPECTED INSPEC BY
7/28/20089:23AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I CONTRACTOR:
LOCATION:
TYPE OF WORK:
- =-_- DATE INSP NEEDED: DATE INSP: r'D
INSPECTED BY:
WORK IN
PROGRESS:_ -.!"ermhn4I
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AS-BUILT:
INPUT: L DATE:_ , , 0. O
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION-PERMITS
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00 T,M FACY
'Name of Firm E G h-5 SERVICE—S CO Phone No., Q 5a
Address of Firm I f a Pbsw 111 a, Roh-t, INI(NP,�OK ut, 00,96
Location of proposed work it 0 G9k4k-Y\ Rohs
Describe fully nature of permit requested RELO&A-yp- k5 M"t) lave, Yv / GTO Rh RrHl�s
A.i` D G V,(14 1;fr51f)5
Starting date A a4O'3 '� -Approx.time for completion 3 k �S
Call Before You Dig No. �®08 30 17a Traffic Services Control No.
Show sketch of proposed work or furnish ;Phis section to be filled out by
two copies of separate drawing Indicate North Town of South'wndsor
Pavement Cut
No.cuts
I Est.-Size of Penn.Patdi s)
Est.PvL ThIcImess in.
EsL Unit Price$
AmL of Deposit$
f ID?05e0 t ev-s-cr G' i4 f{ rM RD Total Due$ by
! — — — - )Cash( -)Check# .
i" tit Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
$
Amt.Due Payee
Amf.Due Town
$
By .
licant is re nsible for )ntacting 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 1 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: Date:
Title: Drivers License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES