HomeMy WebLinkAboutStreet Cut Permits 28 Stephanie Lane (2) 1300012 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 01/31/2013 /
GIS ID: 85800028 = to
FEE: 0.00
MUNIS APPLICATION# 201300110 -- - EXPIRATION DATE:
APPLICANT LOCATION
NAME: YANKEE GAS ADDRE98: 2-9STEPHANIE LANE
ADDRESS: 112 PROSPECT HILL ICU` ITER, ZAINO IEDENTE D
EAST WINDSOR,CT f6tI88 = 28 FRPIANIE LANE
SOUTH WINDSOR,CT 06074
PHONE 860-292-2242 -_ - -
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WORK DESCRIPTION: GAS LEAK — -
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APPLICANT AGREES TO FURNISH THE ibWNA SOUTH Vi D50R E AivIO[TN OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AT& EN B IN Al RED I I� E TQ*N� FOR-MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI< PL UANT i5 F%W VATS AND WILY ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN 0-k OCITF WTi IDS ST EEI GI IT P R11 I"I MANUAL.
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ISSUED BY DA`IE INSPECM INSPECTED BY
1/31/2013 2:33 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1 6b O ) CONTRACTOR:
LOCATION: rl o�
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TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: �2 13
INSPECTED BY: 6Z�5
WORK IN
PROGRESS: OD,
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑NO
AS-BUILT:
INPUT: VIII__ DATE: Is "
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 $25800
Name of Firm a Phone No.
Address of Firm It 2= Zip Code
Locationof proposed work
Describe fully nature.of permit requested a C3 i�` -
Starting date I Approx.time for completion
i Cal(Before.You Dig o: D I � 8 00 7l 7 -Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR.THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB.REPLACEMENT;INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC:CONTROL AND THE TOWN
I CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN&YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
-Show sketch of proposed work or furnish Zhis section to be filled out by
two copies of separate drawing: Indicate North Town of Souuth Windsor
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ Jsf
Est.Patch Cost S
Est.Curb Replacement ft
at Curb Unit Price
Est.Curb Cost a
Est..Traffic Unit Cost s mr
Est:Traffic Control S
Amt.of Deposit$
Total Due S
( )Cash { )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
CONNECT_ION.WITH THIS PERMIT AND THAT I AM FAMILIAR WITH ANg WILL A61DE BY THE RULES AND REGULATIONS FOR-
PERMITS AS OUTLINED IN TH1 TOWN OF SOUTH WINDSOR'$STREET CUT PERMIT TNUAL.
Signed: Date: I,
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
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