HomeMy WebLinkAboutStreet Cut Permits 9999 Pleasant Valley (11) 1100136 TOWN OF SOUTH WINDSOR CT
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PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 09/07/11 -
GIS ID: 72909999 FEE: 00
MUNIS APPLICATION# 201101003 „ - EXPIRATION DATE:
-
APPLICAN LOCATION
NAME: YANKEE GAS DRESS PLEASANT VALLEY ROAD
ADDRESS: 112 PROSPECT HILLS - OWNER. ______TOWN OT, SOUTH WINDSOR
EAST WINDSOR,CT"0688 1540 SUI;LIVAN AVE
SOUTH WINDSOR,CT 06074
PHONE 860-292-2242 -
WORK DESCRIPTION: REPLAG-TESPTATItI�I ANI3 MO TO CAB
APPLICANT AGREES TO FURNISH THE TQWN OF SOUTH VINI3CtR TEE AMOUIIT 6F BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN .R1'I;NSES INCURREDBY TIE,TOWN E(1RMAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT TS FAMI IAR WITH ANIb WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSR'}S--S ET�IJT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
9/7/201111:28AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: l 00 l 3 6CONTRACTOR: a,L
LOCATION:
TWE OF WORK-. Sr S i fi o n G vf-b
DATE INSP NEEDED: DATE INSP:1 1,6�Lz'
INSPECTED BY:_ p1l)
WORK IN
PROGRESS:— `Tz s�- 5 .�-► �. /n,i el -ro
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
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INPUT: CJV DATE: 6 1
W12007 Town of South Windsor INPSECnON REPORT 07
LOW Od 3 APPUCAMON FOR STREEr EXCAVAMON PERM` 1/001
Appl.No. TOWN OF S011TH PWW*No.
PUBL WORKB-DEPARTMENT
1540 SULLIVAN.AVENUE
SOUTH WINDSOR,CT 06074
FEE $26.00
Flame of Firth_ V�z g, 6-q 4 ) Phone No.
Address o#Fin[rt a^ca &mot :T V s,C t v/` j Z}Code a t
LOGatiOrl OfOOSed w�rlc jp�> �,� U� f —John 1 -
Descrbe fully na€um of pm*MWOMd2 �c "1 f fi5 a is.ra c •t /�'1n , 7�ci C, b"
Slatting Me 2LLDo 1 A =Figs for cxarnAe*m, 10 1,30 " o l 1
Call Before You Dig No. o 11340. ` '' Exisft.Water�= RAA Water Well
EaasOng Sewage Service: ❑Public Sewer 0 Septic
PLEASE NOTE; THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY EM MATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATOI AREA,CURB
LENGTH,TRAFFIC.CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAFL
-Show sketch of proposed work or furnish
tests copies of separate drawing This section tabs filled out by
Inc�Cate_Nodh IM of South Windsor
No.cuts-
Est Patch Size(s) _ _ sf
Est.PvL
Est Patch Unit Price$ Jsf
Est.Patch Cost
Est.Curb Repimment ft
Est.Curb Unit Price l- /it
€at Garb Cod-
Est`TrafficUnitCost$ mr
Est.Traffic Conte$
Amt.of Deposit$
Total Due S
( ),Cash (_)Check#
Applicant is respon to for contacting Paid By
the Police Dept.and C.B.Y.D.
1 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 OUTLINED IN THE TOWN OF SOUTH WINDSOMS STREET CUT PERMIT MANUAL
Signed: - Date: "?/�3 / !e?d l/
Title: Driver's License#: 0.3 6 /0 1/0
PLEASE ALLOW AT LEAST TWO 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 ALL TIMES
Street Excavation Perm 88 REV 10-22-M
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w,itlen pbrmiseian of Yankga Gas.? Contractors am urged to OCR Yankee See for further informaeon at Y-80OM—Owe a e: ;e+—Aug-2011
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