HomeMy WebLinkAboutStreet Cut public utility 55 Sandra Driv 900070 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
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DATE: 06/24/09 \\\�
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MUMS APPLICATION# 200900713 ,vQyQo v�Q"v°v����d�� von`°, A\y,v\v�� v`�`vvyvv Av�`��wv v,
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NAME: OCATION
YANKEE GAS �A �a \ �\\ Qv �
ADDRESS: 112 PROSPECT HILL\ Q, y� DRIVE
EAST WINDSOR, CT poon \ \v��uvv° v���� ��Q"v��w "v ;�� ��V Avg �..,.��,„,� EAU ANDRE K
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PHONE 860-292-2242 °
�\ SOR CT 06074
WORK DESCRIPTION: INST
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APPLICANT AGREES TO FURNISH THE TO Op
THE TOWN OF SOUTH WINDSOR FOR ANY
v�k�Q POND REQUIRED AND TO REIMBURSE
CONNECTION WITH THIS PERMIT AND THE AP' y �' °°"` '"aE E° "Q\` "MAINTENANCE OR REPAIR WORK IN
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FOR PERMITS AS OUTLINED IN THE TOWN OF SO AN�4 LL ABIDE BY THE RULES AND REGULATIONS
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ISSUED BY DATE INSPECTED INSPECTED B
6/24/200910:44AM ' PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT*NO.:_3 000?O CONTRACTOR: Jn
LOCATION: ��xtnif i�nP
TYPE OF WORK:
—_.__.. : DATE INSP NEEDED: DATE INSP: a io
INSPECTED BY: 81>
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INPUT: DATE:_ � J 7 _L_______ .
W/2007 Town of Swth Windsor INPSEMON REPORT 07
960 7 J3 APPLICATION FOR STREET EXCAVATION PERMIT 90,0t-) -790
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL .
1640 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm_Y (—,O;L S Phone No. 2-63 6"3 U b
Address of Firm '? Zip Code D C 7 a 1
Location of proposed work S'SC 5,0 ,6n,9 r-
Describe fully nature of permit requested I w, S �� t dz
Starting date ���.S Q �'1 Approx.time for completion - Cr
Call Before You Dig No.200 276Q%( "
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
. .,LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing / Indicate North Town of.South Windsor
No.cuts
Est:Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$. /ft .
Est.Curb Cost$
Est.Traffic Unit Cost$ Ihr
Est.Traffic Control$
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 PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLI THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: J
Title: Driver's License M
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08.doc
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