HomeMy WebLinkAboutStreet Cut Permits 389 Slater Street (2) 1200181 TOWN OF SOUTH WINDSOR
PERMIT NUMBER C I
STREET CUT PUBLIC UTILITY
DATE: 09/19/12 '� --
GIS ID: 83400389
--- -- MUNIS AP-PT T( A PTnrT++_on,��,_�
XPIRATION DATE:
APPLICANT LOCATION NAME: YANKEE GASia
AD RESS: 389, LATER STREET
ADDRESS: 112 PROSPECT HILL�D
OWNER KELLEY SCOTT R&
EAST WINDSOR, CT 06088 = ;
3 I ATER ST
PHONE 860-292-2242 = S TH yvINDSOR,CT 06074
WORK DESCRIPTION: EXCAVTINp IITL
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH IN79SflI TIENIOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPEIFISE�Iwv-k-Raj BY THE TOWN Fp AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TIC APPLICANT 1SAIIL-ZqR WITH qND WII I ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SpIJTH WIAFDSR S STREET"CUT PERMIT MANUAL.
ISSUED BY DA`I'PsI�ISP=E�`I`ED sINSPECTED BY
9/19/2012 12:45 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:_ /.�no CONTRACTOR: Vc,yl
LOCATION:__ ?T
TYPE OF WORK: Yl S'Aa G�� S�i- y; ce
DATE INSP NEEDED: DATE INSP: 3
INSPECTED BY: R
WORK IN
PROGRESS: i.,s- .ILA ez vz � le,54.
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMSfrOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
t640 SULLIVAN AVENUE Date: R 7 ( Z
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm ar) Kee G4.S Se,- v f ce5 Co m �-A Phone No.
Address of Firm I I 2' ?r GS 2�-f" G-�;(( Rd , so F Zip Code G G O 2)9
Location of proposed work 3 91 afe r S'f.
Describe fully nature of permit requested �5 X cG V tr' o r' s S e r v r ce
Starting date Vz o/ /Z_ Approx.time for completion 4 w Z
Call Before You Dig No. 2D 1 z_3$00099 Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE-NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
s e e ci eck S e �C�1 No.cuts
Est.Patch Size(s) sf
0. . Est.Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
{ )Cash O 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 AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:_.I 46L� Date: 7 Z
Title: 14"tee G"S ins tr0Ch Gv1 7e 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
389
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