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HomeMy WebLinkAboutStreet Cut Permits 147 Cambridge drive (2) 1200245 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER STREET CUT PUBLIC UTILITY DATE: 12/14/2012 , GIS ID: 16200147 FEE: 0.00 MUNIS APPLICATION# 201201674 = 1PIRATION DATE: APPLICANT' — LOCATION NAME: YANKEE GAS ADDRESS,; I� =CAIBRIDGE DRIVE ADDRESS: 112 PROSPECT HILL RD' = Q 1E1 MATH*VARUGHESE&MARIAMMA EAST WINDSOR,CT 060�8 14 OAABRIDGE DRIVE SOUTH V�?INDSOR,CT 06074 PHONE 860-292-2242 WORK DESCRIPTION: REPAIIAS IAK IS APPLICANT AGREES TO FURNISH THE 1OW pV SOUT- W���Sf R A�1OUNT OF,BUND REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH WINDSOR FOR ANC EI'ENS1 8�ICLRRED `THE TpN I OR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND THh0PKICA?4 IS A 1V-INN WITTIAI WIIJ ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN O- fiOUTH�VI DSI STR E L CIJT PERMIT MANUAL. ISSUED B DATENPEED INSPECTED BY 12/14/2012 11:05 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** -- faf i TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: o®d V, CONTRACTOR: )a 4. U�e _ LOCATION: TYPE OF WORK: DATE INSP NEEDED: DATE INSP: 1,;2- INSPECTED BY:— WORK IN PROGRESS: 2 4A ircc( GA-s i�c lG p 4,,-3 ee,-, c- i 4� L%k 2 .Ire SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO AS-BUILT: INPUT: DATE: fiA�— S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION 12/14/2012 FRI 10: 00 FAX 860 292 2202 0002/002 APPLICATION FOR STREET EXCAVATION PERMIT Appl.No.. TOWN OF SOUTH WINDSOR Permit No, PUBLIC WORKS DEPARTMENT 1540 SULLIVAN AVENUE Date: a-1�-k 1 S � II , ►� ► i, l; I ,ijI FEE $25.00 Name of Rrrn Q e-a- \A.S Phone No. 8(,0-. ZR Z- Z Z L-( Z Address of Firm (Q S C - Zip Code O&Oc`3 S Location of proposed work Describe fusty nature of permit requested CL itC17T CL -1c 1 ;,-1 S S Starting date o� T--Approx.time for completion d 0 Call Before You Dig No.�, vZ 0�02 / Existing Water Supply: n Public Water ❑Well Existing Sewage Service: ❑ Public Sewer Cl Septic PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB .;LENGTkI,-T�IFFIC-6-ONTR©L-ANQ-T'4HE..TbWNtS..CO.NT.-RAC.'£-OSTS: TfiE-PEfIMANENT PAT-C-H-iS'iyl-picALLY COMPLETED WITHIN-A YEAR OF THE TEMPORAf(Y'PATCH BUT IT COULD BE LATER THAN A YEAR. Show sketch of proposed work or furnish This section to be filled out by two copies of separate drawing Indicate North Town of South Windsor No.cuts Est.Patch Size(s) sf 3 x5 Est.Pvt:Thickness in. ` Est.Patch Unit Price$ /sf oc'm b CI Ct j Est.Patch Cost Est.Curb Replacement ft I( Est.Curb Unit Price$ Iit i Est.Curb Cost$ Est.Traffic Unit Cost$ fir f Est.Traffic Control$ ) Amt.of Deposit$ Total Due$ ( )Cash ( )Check# Applicant is responsible for contacting. Paid By 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 A OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. Signed: r Uv" {. J�-'""k Date: Title: 2 1 Driver's License#: 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 Permit 08 REV 10-22-08