HomeMy WebLinkAboutStreet Cut Permits 518 Pleasant Valley R (2) 1200243 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 12/12/2012 = /
GIS ID: 72900518
MUNIS APPLICATION# 201201668 - I PIRATION DATE:
APPLICANT - = LOCATION
NAME: YANKEE GAS �DDRESs 549=PLEASANT VALLEY ROAD
ADDRESS: 112 PROSPECT HILL RD S 0ER. K�LLEYRICHARD F&JOAN M
EAST WINDSOR,CTib608s - 18 PLEASANT VALLEY
WE
16-10IJ`I'H WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: INSTALL GA VIOL'
APPLICANT AGREES TO FURNISH THE TOWN-4 S�QUT-
R 0[J1I OF-BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYPENSES,IN� bIIE-FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI APPLICANT IS ITH AND WILI ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OEIS
Oi1TI WIISR S REI CUT PERMS T MANUAL.
ISSUED BY ATINSPEED INSPECTED BY
12/12/2012 3:37 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
i --
i -'
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: Vain tep
LOCATION: s/ g Ol ea<n 1 ,a(
TYPE OF WORK:__ i V
r�
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:_A 3" ( 5 / C /►'1c4Z6_
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: �7
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appi. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: I Z•�t•1Z
SOUTH WINDSOR,CT 06074
FEE $25.00 ��ff ��t
Name of Firm Phone No. 101 4;�'"'�
Address of Firma rec 7" ♦ p Code
Location of proposed,
!VT" G
Describe fully nature-of permit requested_ �S'�"" ,r f�11'S 5 figdd C F
Starting date `, Approx.time for completion f
Call Before You Dig No.20 Z S"o t Existing Water Supply: [I Public Water ❑Well
Existing Sewage Service: Public Sewer. ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS-A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB.REPLACEMENT;INCLUDING ANY INCREASES'IN PATCH AREA,CURB.
LENGTH,TRAFFIC CONTROL AND THE TOWNS:CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish 7This section to befilled out by
two copies of separate drawing Indicate.Norih Town.of South Windsor
No.cuts
Est.Patch Size(s) sf-
Est.Pvt.Thickness in.
Est.Patch Unit Prim
�5 Est:Patch Cost$
'Z Est.Curb Replacement ft
Est.Curb Unit Price
Est.Curb Cost 1;
Est..Traff`ic:Unit Cost$ /hr
Est:Traffic Control$
DINT v J�IL(, `r Amt.of Deposit$
I4� Total Due$
k
O Cash ( )Check#
App leant is re'sponsiblelor coffin acti "' '-' Paid By
the Police.De t.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 P MIT AND THAT VAMI FAMILIAR WITH AND WILL ABIDE BY THE RULES:AND REGU_.LATIONS FOR.
PERMITS AS OUT I Ep N TO OF TH WINDSOR'S STREET CUT PERMIT MAN.
Signed: Date; Z` Z • 1 2
Title: l 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
518
VALLE t ROAD
6" X IP 1979