HomeMy WebLinkAboutStreet Cut Permits 450 Pleasant Valley R (2) 1200169 TOWN OF SOUTH WINDSOR, CT
PENT NUMBER STREET CUT PUBLIC UTILITY
DATE: 09/11/12
GIS ID: 72900450
- 201201176 - - -
BXPIRATION DATE:
APPLICANT LOCATION
NAME: YANKEE GAS ADDRESS; 450 PLBASANT VALLEY ROAD
ADDRESS: 112 PROSPECT HILL RDIERf BROCHI BRIAN&KELLEY
EAST WINDSOR, CT 0688 450 P % SANT VALLEY RD
PHONE 860-292-2242 --
OUTH WINDSOR, CT 06074
WORK DESCRIPTION: INST V-w /
APPLICANT AGREES TO FURNISH THE TOWN O SOUTIL4Rm
SjA THFAMOUIti1T OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANSI I<3 PEI IN 3URRED BjffH1;T0WN 0R MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH �IPPLI-CA1T IS FAIL3At WIIFI AID WI1 L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O1K E�UTH W-M.-S S STREE7 CUT PI IPT MANUAL.
ISSUED BY DA' E INSPECTED
INSPECTED BY
9/11/20121:57PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:_A2 C�DJ(o CONTRACTOR:-
-.LOCATION:--
TYPE OF WORK:
V
DATE INSP NEEDED: DATE INSP: 13
INSPECTED BY:
WORK IN
PROGRESS: '`icvo 5 �e r.zsf�`� was S�,rri✓Y
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: 1 1 A I
S/FORMSJOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC.1540 SULLIVAN AVENUE Date: J "�
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm t av) A.,_ qc�3 - - A-. -Phone No. r-
Address of Firm__ I I ;� ' frD— H I(. P ooR Zip Code QZ
Location of proposed work LSD' ll1-MIC �
Describe fully nature of permit requested_ 9KCP_Ju- -e_ ce s S�dyi
Starting dateL S_I;z_ Approx.time for completion
Call Before You Dig No. a/;Z 3-;7-d 13 7-0 Existing Water.Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
-LENGTH;TRAFFIC CONTROL AND THE TOWNS CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
c fi r No.cuts
v Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$. fft
r�•r Est:Curb Cost$
{ Est.Traffic Unit Cost$ Ihr
Est.Traffic Control$
AmL of Deposit$
Total Due$
( )Cash O Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.B.Y.D.
1 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 T WN F SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date-
Title: j--2�� Drivers 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
450
00
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