HomeMy WebLinkAboutStreet Cut Permit 73 Griffin Road (2) 900041 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 04/30/09'
GIS ID:39000073 FEE: 00
MUNIS APPLICATION# 200900422 r. ? q >E ATION DATE:
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1
APPLICA - ; r
s
OCATI ON
NAME: YANKEE GAS
ROAD
ADDRESS: 112 PROSPECT HILT
Al . P DR MICHELLE
`
EAST WINDSOR'C�0 8 s Al FIN ROAD
d THW, CT 06074
PHONE 860-292-2242 � fD SOR'
WORK DESCRIPTION: DIG IOh £35�PW d CUT OFF GAS
SERVE T #£7QN
T`CwI `
APPLICANT AGREES TO FURNISH THE p#6ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR WA WMAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE T I IID WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN T TO OF ST PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
4/30/200912:08PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR YN•SPEMON REPORT
PERMIT NO.: d ,
CONTRACTOR:_ a<Ao--
LOCATION:
TYPE OF WORK:
=— - DATE INSP NEEDED:
DATE INSP: �a
INSPECTED BY:_ i�a
WORK IN
PROGRESS:_
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AS-BUILT:
INPUT: DATE: IA� o—I
W/2007 Town of South Windsor INPSECaON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT OCO
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR f CT
FEE $25-00
Name of Finn �z� Phone No.
Address of Firm / �- iL� S �✓
Location of proposed work `7 6as�F'ii•r 2t7. �� o
Describe fully nature of permit requ a1 i J �BN d d
C4.,� Fig �i 'VtC� iz ! Try e0s'C
Starting date Approx.time for canpietion _ 4:5'I'
Call Before You Dig No. ! 6 t Traffic Services Control No.
WOrli7d3t jf
Show sketch of proposed work or furnish To be Titled out by Town of South Windsor
tw i copies of rate drawing
4t:! -70 �U
In icate North Prop.size of art
No.arts
q. S Tt Bv-
.A mt.of Deposit$ by
O Cash()Chedc#
Sr I+P M Fftr N Cut size after Perm. Patch
No. Cuts
Ez►i2�FiG�N R.f�.
C q Anal Billing$
Amt Due Payee$
# " Amt.Due Town$
73
Applicant is responsible for contacting by
date—
the Police- .-and-C3.-Y.^. - -
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 FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SO R'S STREET CUT PERMIT MANUAL -
Sign Date:
Title: ITT- MA-191 L • flslb T � D.L#•
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
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Standard Fortes\Permits\Sbwt Excavation Permitdoc