HomeMy WebLinkAboutStreet Cut public utility 204 Nutmeg Roa 800161 TOWN OF SOUTH WINDSOR, CT
PFRM,aT NUMBER STREET CUT PUBLIC UTILITY
DATE: 09/11/08
GIS ID: 65100204 FEE: 00
MUNIS APPLICATION# 200801420 EXPIRATION DATE:
APPLICANT LOCATION
NAME: YANKEE GAS ADDRESS 204 NUTMEG ROAD
ADDRESS: 112 PROSPECT HILL RD flWItER HAS E REALTY LLC
EAST WINDSOR, C#'66089 300
1ANC 'ESTER,CT 060450300
PHONE 860-292-2242
WORK DESCRIPTION: INSTALS AN1001 ft ED ANQ o:&NECT TO SAS MAIN
NUTMEG ROAD:SYJ I�IA��� �E SAS
APPLICANT AGREES TO FURNISH THE TOW U T';W.QP C . Q 1. T0F:B
QND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN"Y:EPSES IIU Imo:> 3WI..F( MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE AI*pLf ANTI FANS IAI ITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF QUT1T�?V D. R'.S:STREET GUTPERIVIIT MANUAL.
ISSUED BY ATE INSPECTED INSPECTED BY
9/11/200811:36AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: aLo(� CONTRACTOR: I .�A� V
��
LOCATION: 0
"TYPE OF WORK:_ (,(� UN- j
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:_
AS-BUILT:---
INPUT: DATE: "A" O .
W/2007 Town of South Windsor INPSEMON REPORT 07
S00524 4ze APPLICATION FOR STREET EXCAVATION PERMIT 6®a 16 f
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm Xsy r Phone No. Ze)1 s 6(3 A?
Address of Firm Zip Code
Location of proposed work AJ U Aw Q Sd c L04-
Describe fully nature of permit requested. Al I Lies clo C-
Starting date C— / 0 Approx.time for completion —
Call Before You Dig No.`2.e,)o�1933-0 D
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or fumish This section to be filled out by
two copies of separate drawing indicate North Town of South Windsor
No.cuts
Est:Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price
Est.Patch Cost
Est.Curb Replacement ft
Est.Curb Unit Price$. /ft .
Est.Curb Cost$
Est.Traffic Unit Cost$ Mr
Est.Traffic Control S
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.S.Y.D.
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 ERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLI f HE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed• Date:
Title: /E 1 Driver's License M
.PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08.doc
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