HomeMy WebLinkAboutStreet Cut Permits 807 Pleasant Valley R (2) 1200219 TOWN OF SOUTH WINDSOR CT
PERMIT NUMBER ,
STREET CUT PUBLIC UTILITY
DATE: 11/05/12
GIS ID: 72900807
MUNIS APPLICATION# 201201482- FEE:
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APPLICANTLOCATION
NAME: YANKEE GAS J -DDRES ,., gOLASANT VALLEY ROAD
ADDRESS: 112 PROSPECT HILL
MM-
EAST WINDSOR,CT Of- EI LAVOIE CONRAD J
ul 807 ISLE SANT VALLEY
PHONE 860-292-2242 = OUTI WINDSOR, CT 06074
WORK DESCRIPTION: INSTALL GASERVIC
OM
APPLICANT AGREES TO FURNISH THE TO WI�I�F OUTH V II S 3I2 T =AMOU p AND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN ',BXPI>NSES IN TTRREI J-- T- FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THLAPPLICANT IS F�1�#f.IA WITI �INI1 WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SL7iJTH WI1 T3gi-�"TREI T GU 1 PERMIT MANUAL.
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ISSUED BY DATETNPJCTED
INSPECTED BY
11/5/201210:16AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: a d Cad 19 CONTRACTOR: "-I a vi k ee
LOCATION:_ 20'1
TYPE OF WORK: k Y) SZI,v r
DATE INSP NEEDED: DATE INSP: d —
INSPECTED BY: c3
WORK IN
PROGRESS:— 4 7 C + 44-
Acrcr5 dot r s 5e•,'y,�Q
12
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS—BUILT:
INPUT: C DATE: "
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1640 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $2500
Name of Firm ar_ k e e GG s fie !cCPs__ �`'� Phone No. &b(.') 2 Ct Z - Z Z 1(7
Address of Firm t( Z Pro cp eG-f l_/r t/__Rd___eld _VJi✓_dis?C- Zip Code 06 o 9,8
Location of proposed work 9CJ P( eus a^_j- VA fe
Describe fully nature of permit requested Xx eq vG/ f nct4 Ot
Starting date Moe, 2 G t r- Approx.time for completion a Z
Call Before You Dig No. c(O l 21f O Existing Water Supply: 0 Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY.ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT;INCLUDING.ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
-Show sketch of proposed work or fumish This section to be filled out by
two copies of separate drawing Indicate.North Town of South Windsor
No.cuts
Est.Patch Size(s) sf
A09 Ob 0. Est.Pvt.Thickness in.
(( Est.Patch Unit Price$ /sf
S ,ee
Est.Patch Cost
Est.Curb Replacement ft
Est.Curb Unit Price
Est.Curb Cost$
Est.Traffic Unit Cost$ Mr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash O Check#
Applicant Is responsible for contacting Paid By
the Police Dept.and C.B.YD.
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 THREE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: ,/ Ma,,nc� Date:
Title: i & ° Gdn S`�r-ucA tivl C e-c-k 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
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