HomeMy WebLinkAboutStreet Cut Permits 9999 Foster Street Ex (2) 1200065 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 05/02/12
GTS-m-441()9999 .--
.00
MUNIS APPLICATION# 201200514 EXPIRATION DATE: 05/02/13
APPLICANT LOCATION
NAME: YANKEE GAS ADDRESS: TOWN OF SOUTH WINDSOR
ADDRESS: 112 PROSPECT HILL RD OWNER: TOWN OF SOUTH WINDSOR
EAST WINDSOR,CT 06088 1540 SULLIVAN AVE
PHONE 860-292-2242 SOUTH WINDSOR,CT 06074
WORK DESCRIPTION: FOSTER ST EXT GAS MAIN TEST HOLES IN 4 LOCATIONS
FOR TOWN PROJECT
APPLICANT AGREES TO FURNISH 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 THE APPLICANT IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSR'S STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
R 201210:53AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OFSOUTH WINDSORMSPECTIONREPORT
PETtMIT N0: .�� OOIYTRACIn • E�
LOCATION:
. .'TYPE OF W
DATE INSP tYEEO@:T_____ DATE INSP•
INSPECTED 6Y:
-WORK IN
. -PROGRPSS:
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.. SEPTIC TANK PUMPED,SMASHED,FILLED�.WITNESSED ❑YES ❑ NO
'AS-BUILT:
INPUT:_ f�U� DATE: 1 '`,� • +�,-
W/2007 Town of SoA Windsor iNPS MON REPORT07
APPLICATION FOR STREET EXCAVATION.PERMIT �(Q�"
¢i S�� TOWN OF SOUTH WINDSOR
poi�-� PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
_ 1640 SULLIVAN AVENUE
.SOUTH WINbSOR,CT 06074
- -E - 25.00
-Name of Firm ��•�i ��
- - Phone No. Z--2Zi9-
Address.of Firm I - N�(�
Location of proposed work '�sr 5 ,�{-
Describe fully nature of permit requested E y
5=
Starting date 3 Z Approx.time for completion 2 s
CalBefore You Dig No. 2=1 abe )I 3� I�rZ Ni iS Traffic Services Confrol No. —
Show sketch of proposed worts or firnrish '
two rOpies of separate drawing indicate North This section tobgfijjdajdk
Town of soutbMindsor
Pavement Cut
No.acts
EW Size of Penn.Patct(s)
Est.PvL Thickness_in.
Est.Unit Price S
AmL of Deposit$
TOW Due S by
( )Cash( )Check#
1 STING Pernwnent Patch
No. Cuts
Size of PatdXs)
lz�:stoe
Final Biping
- -,� 19 s
T HpI�� Am L Due Payee
Arnt Due Town
BY
LkWicant is reslAAhe for amtwU
the Poroe 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
PERM OUTtIN THE TOWN OF SO WINDSOR'S STREET CUT PERMIT MANUAL.
Sign "I�( t� Date•-- /3�/12-
Title• � ��'- - .
Driver's License#: —
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES