HomeMy WebLinkAboutStreet Cut Permits 9999 Hayes Road (3) 1100083 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 07/13/11
GIS ID:40209999 � �ii ;
MUNIS APPLICATION# 201100739 FEE: 00
O'IRATION DATE:
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APPLICANT 'S
NAME: YANKEE GAS
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p, LOCATION
IAYES GOAD
ADDRESS: 112 PROSPECT HILL - IEV�df SOUTH WINDSOR
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T 060 8� is . `"� 4p LIL IVAN AVE
EAST WINDSOR,C
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PHONE 860-292-2242 INDSOR,CT 06074
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WORK DESCRIPTION; INST
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>�T� �A��A� NS�VHICH ARE IN
_ CONF ICTI7Outffi e,INAGE/CATCH BASINS-
APPLICANT AGREES TO FURNISH THE TY OTTTI - e
AMP T-0)!pWD REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANAX,5P �11QCU �
PAS I T � �AINTENANCE OR REPAIR WORK IN
�A WEL ABIDE BY THE RULES AND REGULATIONS
CONNECTION WITH THIS PERMIT AND THEE
FOR PERMITS AS OUTLINED IN THE TOWN OFQJTVIDS1V PIT MANUAL.
ISSUED BY DATE INSPECTED INSPECT D BY
7/13/201111:15AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
_ PERMIT NO.:_ 83_- -_ - CONTRACTOR: Ya r-use
LOCATION: W
TYPE OF WORK:_ ��� -e �rCZS /1' °►n i�n y �l7cas4-i d r�<
DATE INSP NEEDED: DATE INSP:�/
INSPECTED BY: e
WORK IN
PROGRESS: &s i n was 2JoC.0,442� 4 {Jlo-', #+,
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑NO
AS-BUILT:
INPUT: DATE: 0
W/2007 Town of South Windsor INPSECIION REPORT 07
APPLICATION FOR STREET EXCAVATION- PERMIT //ODo�
TOWN OF SOUTH WINDSOR —'—� _�
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
'Name of Firm �a�kEe
Phone No. Via- 292-2-2tg
Address.of Firm_ ' I ?rm, ":k �,, �T aEat
Location of proposed work_ ���x ��go
Describe fully nature of permit requested =n6&z11
Starting date_t�x Imo- I�, �I f Approx. time for completion A, s r 2�12
Call Before You Dig Na_ I Ial_` 13 —�
Traffic Services Control No.- _
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North 3311s section to be tolled out by
Town of SwAh'wndsor
Pavement Cut
1 No.cuts
I Est.-Size of Penn.Patch(s)
I EsL Pvt.Thickness in.
EsL Unit Price$
Amt.of Deposit$
4W63 (Z-OA-9
I vu.5T..C65"r _ A Total Due$ by
Gors rtiarr� -
F- )Cash( )Check#
Permanent Patch
No. Cuts
I CH i `s� Size of Patch(s)
I. r Final Billing
I J Amt.Due Payee
Amt.Due Town
By. .
Applicant is responsible for contacting
the Police De t.and C.B.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 P MIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS. UTLI E E TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: 714111
Title: I �f— �►�-�,� Drivers License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES