HomeMy WebLinkAboutStreet Cut public utility 855 Chapel Roa 1000144 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 08/10/10
GIS ID: 18000855 FEE:
MUNIS APPLICATION# 201001020 - 004
TION DATE:
APPLICAN _ LOCATION
NAME: YANKEE GAS ,
ADDRESS: 112 PROSPECT HILL C EL ROAD
g I L POINT CHRISTIAN CHURCH INC
EAST WINDSOR,CT 6eNg8 145
PHONE 860-292-2242 - H SOR,CT 8 60
WORK DESCRIPTION: EXCA p-
APPLICANT AGREES TO FURNISH THE TO S F ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY B O MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE � - I N LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SO S IT MANUAL.
ISSUE BY DATE SPECTED INSPE T BY
8/10/20103:35PM ' PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION:REPORT
PERMIT NO.: CONTRACTOR:_
Q n LOCATION: ?S5 C h q ILOCrCX
r _
TYPE OF WORK:
DATE INSP NEEDED:_
DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: ,y <1
k&
SEPTIC TANK PUMPED, SMASHED, FILLED
WITNESSED EJ YES ❑ NO-
AS-BUILT.
INPUT. . bn DATE: 0 t
W/2007 Town of Sotrth Wlndsor INPSECTION REPORT 07
08/09/2010 MON 14: 31 FAX 860 292 2202 0002/004
APPLICATION FOR STREET EXCAVATION PERMIT
Appl:No. TOWN.OF SOUTH WINDSOR Permit Na.
PUBLIC:WORKS DEPARTMENT
1540,SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT'06074
FEE25.40
Name of'Firm :ate :ee G-i,4 .fie<v.c cps Phone t�lii. $�0� 2. Z Z 2 7
Address.�of Firm' I i 2'`: fi cis � -� ( � �Vk/ n G�scJ �ip.Code d ,Cl .A
Location of proposed wor c.tn a 10 GQ.
C7esoribe fully nature of permit're�uested__,_ ..&-� c�.v.Gfe:. `�o' r �r soh {� : �a.� " s�r yr ce
Starfirt ' 2 3 .i�2.'a_ `U: ' .. .
g.date L Approx.aime>for-completib,
Cali'Before YeU.Dig No.::2. i _C .2 y 3 l �� �� "Existing Water_:Supply ❑;Public INat{e if
Existirag;Sewage Service:.. .. .[] Public Sewer' D Septia
PLEASE NO CE-: THE aEROSIT FOR 7Ht.PERMANENT:PAVEMENT:PATCH AND CURB•REPLACEM.ENT IS A
PRl�LIt1AtNARY ESTlMAT£..THE APPLICANT IS RESPONStSL FQR TFi 1=UI*L FlNA1;.COST OF THE
PERMANENT pATCN' 1NQ:CURB flEPLACiEMENT;aNC),IJDING`ANY:INCREASES�N:PATCH AREA,CURB..
LEN- -H,TRAFFIC.CO.NTR�OL'AND THE TOWN:S:OONTRACT:CQ.STS. -T PERMANENT PATCH IS;TYPICALLY
COMPLETEDWCfHINAYEAR:OF THETEMPOR AIR Y:PATCH;isLgJT:COULD:BEL;ATERTHAN "YEAR.
>Show.sketch of.proposed;work:ar#u'fnish.
This sectionfilled°ut.b'
.,_ two capies:of separatl xlrawirig. ; :;:`.'
Indicate North- .:. : Town of South Windsor_
- ..
-N. Cuts-..
Est. Patch:Size(s) ..
;Esf..Ryt:Thickness . in.
Est.Patch Unit Price$
Est:Patch Cost$
:. _ :C Rep)acereit
�Est, u
Est:
.. . . : ...:�:�.. Esf;Curb Cost: •
. :• : :Est:Traffic.Unit.Cost
•-Est..Traffia Conl:rol.$ .:
'Amt of Deposit
"Total Due.$
._. -. ,(. )_Cash; .:(.)GMeck#
ApPHcarit is:responsible for contactin6 Paid B
the Police De t,ai cd C.B.Y.D..:
y .
f:AGREE:.TO':FURNISH..TQ:1 HE.TOWN OF:SOUTH.WIND$OR THE;AMQUNT,-OF BQNCi.REQUIRED AND:TO.:REIMBU.RSE THE.
fOjIVN;OF." .. TH iNfNDSQR F4.R.A►NY`EXPENSES.INCURREU.BY THE TOWN FOR MAINTENANCE.OR REPAIR WORK IN
GONNECTICN.WIT+1 TN1S PERMIT AND:THAT I Am FAMILIAR WITRANDWEL ABID.E�BY:THE RULES•AND.REGULATIONS FOR:
PERMITS AS.O.UTL(NED:IN'.THE-TOWN OP SOUTH WINDSOR'S STREET 0 TP/ERNUT MAN.UAL'.
Sh nod'.
Title' / a.t f U g Dfter's.License#;
PLEASE ALLOW AT:LEAST TWQ WORKING DAYS AFTER:APPLICATION FOR ISSUANCE OF PERMIT '
WORK MAY NOT BEGIN UNTIL A PERMIT HAS BEEN ISSUED
PERMIT:SHALL BE KEPT ON.JOBSITE AT AIL TIME M.
;. 'Street Excavation pom.08 REY`10.22-06
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