HomeMy WebLinkAboutStreet Cut Permits 9 Bancroft Lane (2) 1200241 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 12/12/2012 �- /
FEE: 0.00
MUNIS APPLICATION# 201201666 EXPIRATION DATE:
APPLICANT LOCATION
NAME: YANKEE GAS ADDRESS 9BtNGROFT LANE
ADDRESS: 112 PROSPECT HILL % ER = GREEN bEREK&JILLIAN
EAST WINDSOR, CT Oi08 = - 9 BANCROFT LANE
= uOU I II V INDSOR,CT 06074
PHONE 860-292-2242 = - '
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WORK DESCRIPTION: INSTAIJ.,G)k VIC -„
APPLICANT AGREES TO FURNISH THE 110"IO SOUT I 1I S4I fi E AfvI0U3 T(1F C}ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYEXPENSES I AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THEAPPLICAN IS FAMJI IA F WITH ANb WII ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OP�sOU'I'H-VINDSR S�TRI-E T CUT - IT MANUAL.
/ l? a � I�3
ISSUED BY DAINSPETED INSPECTED BY
12/12/2012 3:30 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 1 A p I CONTRACTOR:
LOCATION: Cl z2 f L ok ne
TYPE OF WORK: SIC,11 01
DATE INSP NEEDED: DATE INSP: --16, 13
INSPECTED BY: rZ
WORK IN
PROGRESS: \61" elf. Cs-i-S MOO S J a nq /Z� -4-6
Cs9S Ina.`A
08
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
4
APPLICATION FOR STREET EXCAVATION PERMIT
.Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT AA
1640 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $2500
Name of Firm "t
Phone No
Address of Firm �'-. 1. . . -i A� Zip Code
Location of proposed work
Describe fully nature.of permit requested` I K1 j3±rL, 6%&S
Starting date 1 2 13 .1 2. Approx.time for completion
Call Before You Dig,No. -Z0aS1h6z105- Existing Water Supply: (]Public Water 0 Well
Existing.Sewage Service: ❑Public Sewer 0 Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB:REPLACEMENT 1S A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE F LL
—FINAL COST OF THE
PERMANENT PATCH AND'CURB:REPLACEMENT;INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIGCONTROL AND THE TOWWS CONTRACT-COSTS. THE PERMANENT PATCH.IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
.Show Sketch of proposed.work or fumish This seotfon to be filled out by
two copies of separate drawing: Indicate North Town.of South Windsor
No.cuts
Est.Patch Sizes) sf
•�`rr{r� - Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
' Est.Patch Cost s
Est.Curb Replacement ft
Est.Curb Unit Price
Est.Curb Cost$
Est..Traffic Unit Cost$ /hr
Est:Traffic Control$
ArnL of:Deposit$
' Total Due$
O Cash ( )Check#
Applicant is responsible for conta ng 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 PER AND THAT.I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES:AND REGULATIONS FOR.
PERMITS AS OUT INE IN E Ti N OVJUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Sig ned& Dater
�•
Title: Driver's License M
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