HomeMy WebLinkAboutStreet Cut Permits 612 Pleasant Valley R (2) 1200232 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 11/26/12 io
GIS ID: 72900612
TION# 201201573 = EXPIRATION DATE:
APPLICAN Lla
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NAME: YANKEE GAS
REPLHASANT VALLEY ROAD
ADDRESS: 112 PROSPECT HILL RDA WAITE REBECCA E&RYAN A
EAST WINDSOR,CT 060$ 612 IYL ASANT VALLEY RD
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PHONE 860-292-2242
SOUTI V_INDSOR,CT 06074
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WORK DESCRIPTION: EXCAVA B T��NSTN LM A ER S WQ I INS EOM STREET TO
HOUSE
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APPLICANT AGREES TO FURNISH THE TpWN pE OUTFI` 9811R E AMOIILIT( BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYEXPF,N§ES4I ,C— B ' TO�NEOR Iv1AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH&F&fCANT IS 1=A Its V�ITH AND WILD ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOLI I H WINDRR' STREi T-CUTPER1kIIT MANUAL.
ISSUED BY L) E_ I CTED INSPECTED BY
11/26/201211:31AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:_ / A 3 CONTRACTOR: �� n rye
LOCATION:
TYPE OF WORK: o A s-1a�l r G s se v
DATE INSP NEEDED: DATE INSP: S
INSPECTED BY:
WORK IN
PROGRESS: Cc -+-s
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appl.No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT /
1640 SULLIVAN AVENUE Date: 2t (Z
SOUTH WINDSOR,CT 06074
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Name of Firm �a r�'� ee GG� S a r v c c-es Cc- - Phone No. L �Z� Z ` Z Z 47
Address of Firm l Z f e u s p&c. i (( � s W n S G r Zip Code 06 0 �S
Location of proposed work a( 2 f(e-g s 4 v` Vti ((e ca .
Describe fully nature of permit requested —r-X CA vq;(Ic -C 4 a s se,-v r c�5
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Starting date - . z-o( Z Approx.time for completion iD G Zo t 2
Call Before You Dig No._Zd i e 445 2 (oZ S Existing Water Supply: ❑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 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
t e C, "G C-h eGX S(`e�CIYN No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
C Ci 2r0 S 2- 'C(60 G 2 to 7 S' Est. Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
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 AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: /G��-K��(7C�ry Date
Title: �'^2trucfien Tck — YG Driver's License M
PLEASE ALLOW AT LEAST TWO WORKING DAYS AATER 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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CBYD Locate Re west 'Routine)
(CALL BEFORE YOU DIG - CT) 11/15/2012 14:31:36
22-5G YANK/G -C1 -OT -SW
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Date: 11/15/2012 Time: 14:31
Request # 20124602625 PreV4 Request #:
Latitude: 41.8147178 Longitude: .-72.5956976
Address: 612., Streets: PLEASANT VALLEY RD Town: SOUTH WINDSOR
Nearest Cross Street: HOLLIS RD
m Type of Work: EXCAVATE TO: INSTALL GAS SERVICE,
".Area is Marked: -YES
Remarks: WORKING FROM STREET TO HOUSE.
Start Date: 11/20/2012 Start Time: 08:00
Caller: MIKE HANECAK Call Sack:
Phone Numbers (860) 292-2247 Alt. Phone:
Fax #: Email:
Contractor: YANKEE GAS Excavator: YG/RHW/GPL
Address: 112 POSPECT HILL RD. City: EAST`WINDSOR State: CT Zip: 060$8
Were pre-construction marks visible? ❑ Yes ❑ No
_.. ..... ....-._........-......._......._.___.._..._..._.._._._ __.....__-.._...._ __.........._.........._.........._..__...._.....__,__._......_.._..,.._............ _...___......_.........................................................._....._._.............................__........
What facilities were marked? ❑ Main ❑ Service ❑ Both
Main facility material type? ❑ Steel ❑ Plastic ❑ Cast Iron
_. __...._.......-............_._._..,..._..___............__,_.v__..__._......__........_.... ...._.._.__....____......._.__._.. _ _- ____._._... - ____... ... ._.._......_............_._.__...._....._...._........__._.._.__.._....._.................................................................._......_._.................
....._........
Service facility material type? ❑ Steel ❑ Plastic ❑ Cast Iron
How were the gas facilities located? ❑ Conductive ❑ Inductive ❑ Measurements
Where was the connection made? -❑ Meter Value_ _ ❑ Test wire in box ❑ Tracer wire on service ❑ Direct connect to pipe
Did measurements match the signal? ❑ Yes ❑ No _ What was used for measurements? ❑ GIS ❑ Service Card
......... ......
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How was the area marked? ❑ Paint ❑ tokes ❑ Both
Who was the site verbal contact?
Work completed by: