HomeMy WebLinkAboutStreet Cut public utility 155 Gray Road 1000037 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER .owawwomAlft—mSTREET CUT PUBLIC UTILITY
DATE: 03/31/10 _
GIS ID:381.00155
MUNIS APPLICATION# 201000298 FEE: 00
��- - � E .� TION DATE:
APPLICAN= OCATION
NAME: YANKEE GAS S: ROAD
ADDRESS: 112 PROSPECT HILL '
." R R OUGLAS C
EAST WINDSOR,CT 8� aA ROAD
T INDSOR,CT 06074
PHONE 860-292-2242 '
WORK DESCRIPTION: INSTPE
APPLICANT AGREES TO FURNISH THE TO O S. ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY BY O MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE n ILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SO S U RMIT MANUAL.
Z
ISSUED BY DATE INSPECTED INSPECTED BY
3/31/20109:56AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /O DOD 37 CONTRACTOR:
LOCATION: 1 ,5 2,/)Q
TYPE OF WORK:_ 1 N5- 11 LHn io►l on. wnat i v\
DATE INSP NEEDED: DATE INSP:
INSPECTED 'BY:AID
WORK IN
PROGRESS: /2o�
'111V yc-t.c1 cs.r ore
-
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑ YES [-] NO
AS-BUILT:
INPUT: — DATE:
W12007 Town of South Windsor INPSECTION REPORT 07
'161 ° �$ APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL .
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm Phone No.
Address of Firm / Zip Code
Location of proposed work
Describe fully nature of permit requested_ % },�-�/ "Tts
Starting date Approx.time for completion ( •--i! C'
Call Before You Dig No. c;10! Q/ C)
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish
two copies of separate drawing This section to be filled out by
Indicate North Town of South Windsor
No.cuts
Est:Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch'Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Urk Price$. /ft
Est.Curb Cost$.
Est.Traffic Unit Cost$ fir
Est.Traffic Control$
Amt-of Deposit$
Total Due$
O Cash O Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.S.Y.D.
AGREE TO FURNISH TO THE TOW_ N 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 OUTLIN (,M�THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed• / Date: s~Z 1 —/G
Title: 462 Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavadon Permit 08.doc
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