HomeMy WebLinkAboutStreet Cut Permits 75 Natsisky Farm Road (2) 1200246 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 12/19/2012
GIS ID: 62300075 — FEE: 0.00
MUNIS APPLICATION# 201201686 - EXPIRATION DATE:
APPLICANT, LOCATION
NAME: YANKEE GASe AdADDRESS„ 74 i4 AiSKY FARM ROAD
ADDRESS: 112 PROSPECT HILL RD ER' LIbOW hkMIE R&JOYA N
EAST WINDSOR,CT-fl6`O9S - = 75�WA"TS SKY FARM RO
SOTJTH WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: REPIfAIT0 C-L-CR AL01 AStIC --
APPLICANT AGREES TO FURNISH THE Ti?WNOF OUTH W D R TI A�IOU- -f OF.BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANPEFTSESTxi TK'GI�b BSI HE TOWN POR IyAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI AR CANT IS FA1V J�ik�Z WIT-I ANI�WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO WN OF S UTPI�yI 7SR S�TREE' �[�PER11rI3T MANUAL.
ISSUED BY J DATE IMPEIED INSPECTED BY
12/19/2012 10:42 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /off O ct a L& CONTRACTOR: Yolatagd-s
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LOCATION: 7.S nGt+e, f < �!lA �le_CY1
TYPE OF WORK: 12I Q 2 s Sic,U t c e,
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: $�
WORK IN
PROGRESS: efOA7 car
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: �•
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
.Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT ` f �--
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm Phone o.
Address of Firm jj`r Zip Code
Location of proposed work 75- So
Describe fully nature of permit requested t G
Starting date Approx._time for completion
Call Before You Dig No. Existing Water Supply: E]Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or famish This section to be filled out by
two copies of separate drawing Indicate North Town.of South Windsor
No.cuts
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price
Est.Patch Cost$
Est.Curb Replacement it
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
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 13Y 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 OUT IN T TOWN OF SOU 1`H WIIVbSOR'S STREET CUT EEItMIT UAL.
Signed: Date: / /7. �,
Title:
�d �G Driver's License#: t
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
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