HomeMy WebLinkAboutStreet Cut Permits 52 Ronda Drive (3) 1300001 TOWN OF SOUTH WINDSOR CT
PERMIT NUMBER ,
STREET CUT PUBLIC UTILITY
DATE: 01/07/2013
GIS ID: 77100052
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EXPIRATION DATE:
APPLICANTirAAM
NAME: YANKEE GAS LOCATION
ADDRESS: 112 PROSPECT HILL D _ ADDRESS, 52 RONDA DRIVE
EAST WINDSOR,CT 66$8 = %fI ER-- WEIMAI�SCOTT C
52. R-ONI5A DRIVE
PHONE 860-292-2242 = 0UTH WINDSOR, CT 06074
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WORK DESCRIPTION: EXCAV T- A-T S�IsIS
APPLICANT AGREES TO FURNISH THE TOWN OT SOUTH ViIIN�DSO �E AMOINT(�F BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY RXPENSF�S INp}III3E TOWN POI��I�IAINTENANCE OR REPAIR WORK IN
ND TH9
CONNECTION WITH THIS PERMIT AAPFLI BIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN(*SOiTIISI3' T I ICUT p;ERIYIT MANUAL.
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ISSUED BY ATE INS ECTED INSPECTED BY
1/7/2013 9:18 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: / J OC'60 CONTRACTOR:
LOCATION:_ s a �,� Gi. br\ .
TYPE OF WORK: lY1 S'zx
1 l � V 1 c_e_
DATE INSP NEEDED: DATE INSP: aY It 3
INSPECTED BY:-
WORK IN
PROGRESS: .A `7� � 3Q C IN!'t, —i o t.i,`5i dl Crcz S°
C -rb /1&o(e
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ DATE: �1
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 $2500
Name of Firm (4s. Slarvcces COM Gn Phone.No. ` Z-92 - 22y(7
Address of Firm c t r spec' ��r i'/.jG'eP. gr c 7- W r el cLsr�� Zip.Code o Is G ��
Location,of proposed.work " Z:.. 'R o r A CC r t v'e
Describe fully,nature.of permit requested 199 cA 11r.4 f2> i h s� 4 CIS lss e' v
Staring date Approx.time for completion 2 r 3
Call Before.You Dig.No: L 2 d 1 3 U 100. 7(P Existing,Water Supplyr �Public Water �Well
Existing Sewage Service: (]Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR.THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB.REPLACEMENT;iNCLUDINQ ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT-COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN AYEAR OF THE TEMPORARY PATCH BUT IT COULD-BE LATER THAN A YEAR.
-Show sketch of proposed work or fumish This section to be fined out by
two copies of separate drawing: Indicate.North Town of South Windsor
No.cuts
�L (( r Est.Patch Sizes) sf
S rr Tf CaG eOt ..i Ke c J'1 Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price
Est.Curb Cost S
Est..Traffic Unit Cost$
Est:Traffic Control S
Aim of Deposit$
Total Due$
O Cash O Check#
Applicant is responsible for contacting ; Paid By
the Police.De t.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 AIDE BY THE.RULES:AND REGULATIONS FOR
PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMITT MANUAL.
Signed: Date: 1/3 t t 3
Title:, Y G ` Go Lt. -re k 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:Penn*08 REV 10-22-08
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'BEFORE YOUDIG - OT. ' O1/0;2/2Q13 15�50 2.5
15j 5G,YANK/G -CZ J1 -0T
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quest # 2Q13010;Q76Q Prev Request
�y titude: 4 8176.8Y2 Longitude': 72 :5982,513'+r
eSs.. 52 3trppt, RONDA DR Town: SOUTH WINDSOR
`N are'st Cross Streat ICI TOI* .Z• L
Q e of Works., EXCAVATE TO •INSTALL GAS' SERVICE,'
es is Marked: YES• -
rksF: W,<1RKING,FROM STREET TO HOUSE.
3 rtlDate: Start Tiate: Q8.00
C ller: MIKE HNECAK Call.Back.
^t;P one 'Numbe 72,247 Al.k Phoney
E' x # ' Email
C nt=actor:: YANKEE.GAS Exeavatar. , YG/RHW/GPL
T H2'7,L��RD Cit EAST WINDSOI� � State: CT ��Zi:p: 060&8
Address 21,2 PROS�EC, Y
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Wer pre-construction marks visible? ❑ Yes ❑ No
Wh facilities were marked? ❑ Main ❑ Service ❑ Both
Mair facility material type? ff Steel ❑ Plastic ❑ Cast Iron
Service facility material type? _ ❑ Steel ❑ Plastic ❑ Cast Iron
How were the gas facilities located? ❑ Conductive ❑ Inductive ❑ Measurements
.W...._._.._.v_._.._._.._.._.__...._......
Whe a was the connection made? ❑ Meter Value ❑ Test wire in box ❑ Tracer wire on service ❑ Direct connect to pipe
Did i easurements match the signal? ❑ Yes ❑ No What was used for measurements? ❑ GIS ❑ Service Card
How was the area marked? ❑ Paint ❑ Stakes ❑ Both
Who was the site verbal contact?
Wor completed by: