HomeMy WebLinkAboutStreet Cut Permits 742 Pleasant Valley R (2) 1200170 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 09/11/12
GIS ID: 72900742 --
MUNIS APPLICATION# 201201177 FEE: .00
RXPIRATTON i)ATF•
APPLICANT, , LOCATION
NAME: YANKEE GAS ADDRESS, 742,PLSANT VALLEY ROAD
ADDRESS: 112 PROSPECT HILL D ' qjft
EgsETSKY MARY J
EAST WINDSOR, CTM608$ 742 PLEASANT VALLEY
= -- TH WINDSOR,CT 06074
PHONE 860-292-2242 - _
WORK DESCRIPTION: INSTAL,LGAS VI
APPLICANT AGREES TO FURNISH THE TOWN OF SOLf1H WIN?S¢1R =AMOU1kT QF BCJVD REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANC E PEI SES IN TIET $ TI E TOWN FOI IV AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE AP1CAL�iT IS)tiA1t IAR V1rITI AND WILT ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OTC OT TH WINI]SIt S_TREI T GATT p1 RMIi MANUAL.
--IS �3
SUED BY DATE-IN TED INSPECTED BY
9/11/2012 1:59 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: M 00 176 CONTRACTOR: 41a f7 kee
r
LOCATION:__7Yt2_ V��'-V-_<C721-
TYPE OF WORK: slp_� i f
DATE INSP NEEDED: DATE INSP: / sue'
INSPECTED BY:
WORK IN
PROGRESS: o c;� ,+� .� (� I�� s ycj)(o�
�X 3 0 5- 3 ` -k Cr
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:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm - -- r� - - qLA-s ,O Phone No.
Address of Firm ?(e2 s - t-t I L_kL Q 0 A-t Zip Code_0&006
Location of proposed work Z. i 0#06D
Describe fully nature of permit requested eve o
Starting date q- �� Approx.time for completion S
Call Before You Dig No. 62019 2'700 Existing Water.Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH;TRAFFIC.CONTROL AND THE TOWN'$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
No.cuts
AHCtc,�C�
Est.Patch Sizes) sf
0. . Est.Pvt.Thickness in.
Est.Patch Unit Price
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price.$.. ]it
Est:Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit S
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 AS OUTLINE. IN E TO N UTH WINDSOF'S STREET CUT PERMIT MANUAL.
Signed: Date• 02—
Title: �-' `^ 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.
742
. J _
VA LLej
�1�C14�k'CE
P�1�
Molloy, Catherine
From: CallCenter@CBYD.com
Sent: Monday, September 10, 2012 2:50 PM
To: CBYD
Subject: Locate Request-20123700855
(CALL BEFORE YOU DIG - CT) 09/10/2012 14:49:35
-5G -C1 -OT -Si
23-SW SWINDS -T5 -W3
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*** REMOTE BATCH ENTRY ***
***** ROUTINE *****
TIME. .14: 49 DATE. .09/10/2012
REQUEST NO. . .20123700855
LATITUDE. .41.8125458 LONGITUDE. .-72.5894039
TOWN. . . . . .SOUTH WINDSOR
ADDRESS. . .742
STREET. . . .PLEASANT VALLEY RD
NEAREST
CROSS STREET. .LONG HILL ROAD
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TYPE OF WORK. . . . .EXCAVATING TO INSTALL GAS SERVICE
AREA IS MARKED. . .YES
REMARKS:
WORKING FROM STREET TO HOUSE
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START DATE. . . . . .09/13/2012 START TIME. .08:00
CALLER. . . . . . . . . .MIKE APPLEBY
CALL BACK. . . . . . .8-4:30
PHONE #. . . . . . . . .860-437-4117
FAX #. . . . . . . . . . .860-437-4191
ALT. PHONE #. . . .
EMAIL ADDRESS. . .
CONTRACTOR. . . . . .YANKEE GAS SERVICES
ADDRESS. . . . . . . . .179 CROSS RD
CITY. . . . . . . . . . . .WATERFORD
STATE. . . . . . . . . . .CT
ZIP. . . . . . . . . . . . .06385
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EXCAVATOR DOING WORK. .YG CONST, GPL,BURNS,RH WHITE, NPL
ISSUED TO: DATE: TIME: BY:
DATE/TIME ARRIVED: TIME LEFT: COMPLETED BY:
CALL BACK: 1) DATE: TIME: BY: 2) DATE: TIME: BY:
PERSON CONTACTED: PERSON CONTACTED:
1
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