HomeMy WebLinkAboutStreet Cut Permits 529 Graham Road 1100183 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 12/19/11 = "
GIS ID: 37500529 , , FEE: 00
MUNIS APPLICATION# 201101519 = = , EXPIRATION DATE:
APPLICANV LOCATION
NAME: YANKEE GAS ADDRESS: 529 GRAHAM ROAD
ADDRESS: 112 PROSPECT HILL Rl " £� tER: PUTA TIMOTHY S&
EAST WINDSOR,CT,06I188 52� `;GRAHAM ROAD
-SQUTH WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: INSTALS NEW SAS SERVICE
APPLICANT AGREES TO FURNISH THE'r0WN,OF=SOUTH-W.-M-0-RR ICE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANI'=EXPENSES IN66kRlEDB THI TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THiAI�PLIGANTIS FAMILIAR WITH ATD WFT,L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SQiJTIi WINDSR'S STRE T CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
12/19/20118:59AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
......... ....._.......... ......... --
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: / ®®/Y3 CONTRACTOR: a
LOCATION' (A Z d
.TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
- s
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
'AS-BUILT:
INPUT:_ f DATE: V"k
W/2007 Town of South Windsor INPSECTION REPORT 07
12/09/2011 FRI 15: 15 FAX 860 292 2202 0002/003
x APPLICATION FOR STREET EXCAVATION PERMIT
h TOWN OF SOUTH WINDSOR
r . PUBLIC WORKS DEPARTMENT
' TOWN HALL
1540 SULLIVAN AVENUE
y
SOUTH WINDSOk CT
FEE $2S.00
3"
Name of Firm aA/ e�e Phone No.
Address of Firm l'2 �' tL-t--
Location of proposed wo + �
Describe fully nature of permit requested &'
starting date I——1 q 1 AppnmL time for a wyletion_
Cali Before You Dig No.`216 1/ Traffic Services Control No.
S.
Show sketch of proposed work or furnish filledgut Town of South Windsor
'.
two copies of separate drawing
:. Bment tut
Indicate North we Of cut
a: No.outs
"Amt.of Deposit$ by
. O Cash O Check#
- Cut size after Perm. Patch
fWv-jq re No. Cuts
...' Final Billing$
AML Due Payee$
r -I Amt.Due Town$
y.
-: Applicant is responsible for contacting L. J ` by date
RE: the Police Dept and C.B.Y.D.
I 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 WINDSOR'S STREET CUT PERMIT MANUAL
_;. Signed Date: t
Title: D.L#: : -�17k
... PERMIT SHALL BE KEPT ON JOBSIM AT ALL 17ME5
1 Standard Forms\Permits\Street Excavation Permitdoc
, ;
s
3�.
,Vol
is
V��