HomeMy WebLinkAboutStreet Cut Permits 61 Hilton Drive (2) 1300014 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 02/14/2013
GIS ID:44100061 = FEE: 0.00
�I:4UNIS APPLICATI Pd t-201300133 XPI!ON DA Eo
APPLICANT LOCATION
NAME: YANKEE GAS AIDE : �f IILtON DRIVE
ADDRESS: 112 PROSPECT HILL ROTEl FABRYKI MARY&COREY C
EAST WINDSOR,CT�-8 HILT N DRIVE
O°UTH)YINDSOR,CT 06074
PHONE 860-292-2242 _
WORK DESCRIPTION: REPAIR .ASAK
APPLICANT AGREES TO FURNISH THE TOWN(F SOLPTH �SOR TFIE-=AMOM-T Off'BAND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY 1 I'E ES J,UI RED BY 11-TQ" 6t6 AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THl♦APPLICAN I TS FAIc1 Its WITS ANDJTL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OE SOi1TH WIND-S1t TREE CUT PERMIT MANUAL.
ISSUED BY DATE-INPECTED INSPECTED BY
2/14/2013 11:17 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: - . i CONTRACTOR: �Q
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:��2
INSPECTED BY:
WORK IN
PROGRESS:_ A y ` X -'31 r� � ✓'�' /wa UJ
Lea
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: f,�'` DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
ti APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Dater d`S
SOUTH WINDSOR,CT 06074
/ FEE$2500
Name of Firm ! Phone No. `��" P
Address of Firm Zip Code
Location of proposed wok-4 I di ,
Describe fully nature.of permit requested
Starting date /t Approx._time for completion
Call Before.You big.N : D 1 go 7002Existing Water Supply: 0 Public Water Well
Existing Sewage Service: 0 Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR:THE PERMANENT_PAVEMENT PATCH AND CURB:REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT'PATCH AND CURB REPLACEMENT,INCLUDING.ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC:CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A-YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate.North Town of South Windsor
No.cuts
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /it
Est.Curb Cost S
Est.Traffic Unit Cost$ fir
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&S QUTLINEb IN_T E TOWN OF SOUTH WINDSOR'S STREET CUT P RMIT MANUAL.
SI,-n A Date:
Title: 44
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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