HomeMy WebLinkAboutStreet Cut Permits 30 Kennedy Road (2) 1200136 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 08/01/12
GIS ID:49800030 FEE: 00
MUNIS APPLICATION# 201201002 EXPIRATION DATE:_ __ _ _ __
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APPLICANT % = LOCATION
NAME: YANKEE GAS _ADDRESrSs k KENNEDY ROAD
ADDRESS: 112 PROSPECT HILL RD JOHN J JR
EAST WINDSOR,CT_0608`8 34)Vt�0ICOCK DRIVE
SOU I'H V INDSOR,CT 06074
PHONE 860-292-2242 i ,
IF
WORK DESCRIPTION: EXCAV N T�1 INSTARL A RIB E I�1IN IS BEHIND CURB LINE
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTFI Vi�II�IISITBEvI0U1 () pND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES IN tI �I� ' I°HE LO NEpR 1 IAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THIiAPPLCANT IS I{AYAR Wr11 A VC�ILI ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OI S6i7fiNVINDSRTREI T CUT PERIyIIT MANUAL.
ISSUED BY DATE IN PD ED INSPECTED BY
8/1/201211:55AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: A96 0136 CONTRACTOR: `��i v� L e
LOCATION: 3D -enYvt-a �4
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 1 - y
INSPECTED BY: D
WORK IN
PROGRESS:_—irA s 6,+5LeA ZviA yp_yJ
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
1540 SULLIVAN AVENUE Date: 7 25 (t
SOUTH WINDSOR,CT 06074
FEE $25.00
KIaM_MVirm 16A ("sG ct�O�.f_C �' _ i _ l l �7Gn
-one o. _
Address of Firm !t 2. ?rUs pPc:f-O i(/ 2c.� a s'�- 'y4 i r ts�i; -- Zip Code 06G6 a
Location of proposed work 310
Describe fully nature of permit requested_ ICY c.G v GS �6 ✓?s f f a 4 S er y i ce
GGs rn ri 15 he h14a1 nj rb 1101
Starting Approx.time for completion a 0 ( 2
Cali Before You Dig No. 201 2 2 70 2$ 5 9 Existing Water Supply: ❑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
I..ENGTH,'TRAFFIC CONTROL AND THE TOWNS 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 T_ hls 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$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price
Est,Curb Cost-$,
Est.Traffic Unit Cost$ /hr
Est.Traffic Control S
AmL of Deposit$
Total Due$
{ )Cash ( j Check#
Applicant is responsible for contacting Paid B
the Police De t.and C.B.Y.D. Y
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 F SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date,-.
Title: n,sf-rud- ' �cG�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 PE'V 10-22-08
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bequest #. 0122702859 Prev E2equest #
Lat tudew 41 85.4430 Lon4itude 72• 8 j564
Aiidress� 30 _.. Street KEIP.] y ItA Town SOT7TH WI1D8QR ,
Nearest G�P,gS Street. SULLIVZ AVE
e o Work EEC.,T 3 INSTi LI G135 8ER 7I
mrked: ! Ea ,
Remarks WQRKIIC STRE Tt� C7tJ5E
Start Date {7 � / 0 2 Start :Tyne: Q 5QA
7 0 Y
Phone Number � $$q 29 ��297 � � Rhone t
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860 2i9t�i
Canrtz�x 3AI�L ` oavatt�r x 'SAMEI °F LlR H t HITE
Addre t ( 112 BR S ECT H L D pity EASE GdINDSOR State CI Zip 06088
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Were pre-construction marks visible? ❑ Yes ❑ No
_ . ....._. ..._........_.. ,....._..__ ...................................__ , ,... . _.._..._...... .......................................... ................................................... ......................................._. . .......... ......... .......... ......... _.........
What facAl ties were marked? ❑ Main ❑ Service ❑ Both
Main facility material type? ❑ Steel ❑ Plastic ❑ Cast Iron
_...._..... __ ._._. ._._ m,. .. . _,..... _m. ..-,. _.._ _ ..,. ....... .... _. ...,.. .. ._.__._ .... _ .._... ... ....
Service facility material type? ❑ Steel ❑ Plastic ❑ Cast Iron
How were the gas facilities located? ❑ Co uctive ❑ Inductive ❑ Measurements
.;..._.�......................._....._........._._........_............._........._...._...................................�..__�_......._........................._...._.._.._.._.._......_..............................__..........................................._..._............._........................................._.........._............._...
. _.._.._....._.__..._.._......._......_..,......,.........._.............._...............__....,.._.........._.
Where was the connection made? ❑ Meter Value ❑ Test wire in box ❑ Tracer wire on service ❑ Direct connect to pipe
Did measurements match the signal? ❑ Yes ❑ No What was used for measurements? ❑ GIS mm❑ ServiceCard
How was the area marked? ❑ Paint ❑ Stakes ❑ Both
Who was the site verbal contact?
—., __ _......._.._........_._ ....._.._........_.._ — _ _ ._.................................................................................._..._.....__........_.................._.........._..._..-,._.__................_................................._..............._...__._...._._. _..........__..__._.___...._.... .._.........................................
Work completed by: