HomeMy WebLinkAboutStreet Cut Permits 122 Debbie Drive (2) 1300002 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 01/08/2013
GIS ID:26700122 FEE:
MUNIS APPLICATION# 201300025 0.00
FX P T R A_TI ON-1A_T_P-
APPLICANT lkLOCATION
NAME: YANKEE GAS A15DRESS ; 122EBBIE DRIVE
ADDRESS: 112 PROSPECT HILL D > 1EI LhPAGIsJOHN R IV&PAIGE A
EAST WINDSOR, CT_
12 DI B3IE DRIVE
PHONE 860-292-2242
�= „ tJUTH,WINDSOR, CT 06074
WORK DESCRIPTION: REPMR-iA x( V '
APPLICANT AGREES TO FURNISH THE TOWN OF SOU)H-_' INT) q�2 IHE'AMO>JI*IT OIL BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AA&ENSE�INE�IRE,BXHE TOWN FOR IYfAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI,AP CANT IS I A 1 WlTI3 AI D V�ILI ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE O WN OF SOTIj WI�1DSR' TET GIJT F'ER1I3 MANUAL.
ISSUED BY DATE SPETED INSPECTED BY
1/8/2013 10:20 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1 3 0000, CONTRACTOR:
LOCATION:
TYPE OF WORK: L�_
DATE INSP NEEDED: DATE INSP: ` /3
INSPECTED BY:
WORK IN
PROGRESS:_
:nZ5 's,oC Je ,
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C DATE:
7
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT 7
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm al. L— yeas- - - - -- Phone No.
Address of Firm /l _roMe—Xf _f�r1 = - '�-� t' .SrN- -Zip Code o
Location of proposed work-/�--a--. --- S LAD its_ cry
Describe fully nature.of permit requested o
Starting`date 0 Approx.time for completion . 7
Call Before You'Dig o:a0130400�90 Existing WaterSuppiy PubiiciNater ❑Well
Existing Sewage Service: ❑Public Sewer El Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
:PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB-REPLACEMENT;INCLUDINQ ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH-IS TYPICALLY
COMPLETED WITHIN -YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or fumish This section to be filled out by
two copies of separate drawing Ind icate:North Town.of South Windsor
No.cuts
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ fft
Est.Curb costs
Est..Traftle Unit Cost$ lhr
Est:Traffic Control$
Amt.of Deposit$
Total Due a
O Cash O Check#
Applicant is responsible for contacting Paid By
the Police.Dept.and C.B.Y.D.
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 UTLINED IN TH T WN OF SOUTH WINDSOR'S STREET CUT J—z
ERMIT MANUAL.
Signed: Date:
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 P"10-22-08
zo �9d
/0/
40(
SON
�9
�Q
c3j'' Dc
1:250 1"=20.8
(� \� W
N
v N
O
N
d%
Q�e
i
Ln
ctl
so
9
6l zz