HomeMy WebLinkAboutStreet Cut Permits 71 Wentworth Drive (2) 1300010 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 01/31/2013
GIS ID: 93300071 - „ FEE: 0.00
MUNIS APPLICATION# 201300105 11XPIRATION DATE:
APPLICANT = LOCATION
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NAME: YANKEE GAS - ADDRES 71 ITT WORTH DRIVE
ADDRESS: 112 PROSPECT HILL RD �1+lERt R 1SSEll DOUGLAS K&SARA J
EAST WINDSOR CT 46&8 =
71 VENWORTH DRIVE
PHONE 860-292-2242 /--WU- TH WINDSOR CT 06074
WORK DESCRIPTION: GAS E
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH AIvIOUIIT 6F BGPD REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANC'E 'EN 1 S IN 111 irD HYT TOV N FOT MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI��.PPLICAI�IT IS E1CIITAWITH AND WILD,ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOIL I'II.�VTi1DS3 STI T'CUT PERIfi MANUAL.
ISSUED BY Eik-T- FAi D INSPECTED BY
1/31/201311:36AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 13w01 D CONTRACTOR:
LOCATION: 71 "OT W6ifS'f 1Jr'"
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 2
INSPECTED BY:
WORK IN
PROGRESS: (s � "' 14",
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appi. No. TOWN OF SOUTH WINDSOR P rmit No.
PUBLIC WORKS DEPARTMENT d f
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $2500
Name of Firm l Phone No. — .
Address of Firm To Code
Location of proposed work
Describe fully.nature.of permit requested
Starting dateV T,04 �3 Approx.time for completion
Call Before-You Dig No.- " Existing Water Supply: 0.Public Water ❑Well
Existing Sewage Service: Public.Sewer Septic
PLEASE NOTE: THE DEPOSIT FOR.THE PERMANENT PAVEMENT PATCH AND CURB.REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB:REPLACEMENT;INCLUDING ANY INCREASES IN PATCH AREA,CURB:
LENGTH,TRAFFIC CONTROL AND THE TOWWS CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show Sketch of proposed work or fumish his section to be filled out by
two copies of separate drawing : Indicate North Town of South Windsor
No.cuts
Est.Patch Sizes) of
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost;
Est.Curb Replacement ft
Est.Curb Unit Price$ /It
Est.Curb Cost S
Est.Traffic Unit Cost$ fir
Est:Traffic Control S
AmL of Deposit$
Total Due$
O Cash O 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 FQR MAINTENANCE OR REPAIR WORK IN
CONNECTION.WITH THIS PERMIT.AND TNAT;I AM FAMILIAR WITH AND WILL ASIDE BY THE.RULES AND REGULATIONS FOR:
PERMITS OUTLINED IN TH INN OF SOUTH WINOSOR'S STREET CUTS rR�MIT MANUAL.
Signed: -.._. Date:
Title: I _ '� 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 Exeavatlon Permit 08 P"10-22-08
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