HomeMy WebLinkAboutStreet Cut Permits 175 Wheeler Road (2) 1200209 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 10/22/12
GIS ID: 93900175 FEE: .00
MUNIS APPLICATION# 201201414 RPIRATION DATE:
APPLICANT LOCATION
NAME: YANKEE GAS =AISDRE% 175--WHEELER ROAD
ADDRESS: 112 PROSPECT HILLJ: = 1 IIER KF PROPERTIES LLC
EAST WINDSOR,CT 008 1 T WHIIELER RD
SUU=TH lyINDSOR, CT 06074
PHONE 860-292-2242 WAR
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WORK DESCRIPTION: EXCAV-ATE f IS I�r A r EMINOTE THE ROAD IS SLEEVE
THEREF RE DX 1 i 32A-M T1 WII1L O I YB O v MAIN
APPLICANT AGREES TO FURNISH THE SOWN OF SOiJfiHINDSt71�TIBE NOWT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN C E�PENSEis IN TOWN F MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI APKAC 0W 1S III ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE, C� OT1TH yV11fID�Z STREET CUT I?ERM1T MANUAL.
ISSUED BY DA-TE INPEC TED INSPECTED BY
10/22/2012 10:44 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: a�d�D / CONTRACTOR: Ya 'o
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LOCATION:_ 1'7 5� h-e-0- Z
TYPE OF WORK: ) o ta js
DATE INSP NEEDED: DATE INSP: 1
INSPECTED BY: F3 Ir->
WORK IN
PROGRESS: �'e jAl ex k �d 40
7S-
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: Lttll_l DATE:-- " 3 ' 13
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: l0�(? Z
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm 9 4 K e e G4 c S e.r,/4 4 es C a M A y Phone No. &00
Address of Firm t t 'L L4.(( I?c Zip Code—Ai 6 88
Location of proposed work 1 S' W h etIet- d
Describe fully nature of permit requested 6L c4 wv C e s �( 4 N
fie. re s S e e%le- +6,e t e for d2q. v4i C"n wi b dyer n� ;rt.
Starting date OC4-. z o l 2 Approx.time for completion Nov. ZO t 2
Call Before You Dig No. Z U 12 '-4 2 D 13 ! 5 Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer El Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate.North Town of South Windsor
No.cuts
'7 S Est.Patch Size(s) sf
Nov 8 D 0
Est. Pvt.Thickness in.
Est. Patch Unit Price
s G E / '�Y�#GC� StC C• G(f Est.Patch Cost$
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 ( )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: M GG�I GI'yflut�(',/ Date: 104/7 /Z,
Title: !cLoKee G4 s Can St- C�� Driver's License M
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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