HomeMy WebLinkAboutStreet Cut Permits 6 Bancroft Lane (2) 1200220 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 11/05/12
GIS ID: 07200006
MUNIS APPLICATION# 201201483 RPIRATION DATE:
APPLICANT, ` ., —„ LOCATION
NAME: YANKEE GAS
DDRES 61A1VROFT LANE
ADDRESS: 112 PROSPECT HILLtD - ER - SCHUNDER JEFFREY P&KELLY C
EAST WINDSOR, CT 06 88 % 6 aANRO CFT LANE
DT INDSOR CT 06074
PHONE 860-292-2242 =
WORK DESCRIPTION: INSTAIsI GARV�CEIF�AIl3 IOlI3OLsJ �20A7
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APPLICANT AGREES TO FURNISH THE EQ W*I DkS0UTH I1�IDSt J 1I AMQIJ T OF-B(3ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AA-RPENSES I1*TO Ia�Y THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT ISALrAR WITHAI>ID WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O UTH WI�1I?SR' STR�EF CUT,PEIIT MANUAL.
ISSUED BY 0 DATE I'E TED INSPECTED BY
1 1/5/2012 1 0:19AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /oq ® CONTRACTOR: o h ke e
LOCATION:_ +
TYPE OF WORK:_ n 5 i isc v i `� �n C�
DATE INSP NEEDED: DATE INSP: Z
INSPECTED BY: eO
WORK IN
PROGRESS:_ Cc <
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: 3
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:
SOUTH WINDSOR,CT 06074
e-re- n.nr nn
Name of Firm \/4 y\y\e e (;G s 94? r V r c e5 CG m na A �Phone No.� ,) 2 9 Z - 2 -2 7
Address of Firm 112, P rc.K ec:" ;l( C G sf A' s oc Zip Code Gb o S
Location of proposed work 4 h c'ro q o e
Describe fully nature of permit requested C>< e�v��e o r s 4 Sep r c e S
Starting date Nl cV•. 2 o t 2 Approx.time for completion No 1. 2U 12
Call Before You Dig No.2a1 Z 4 q0 123 9 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 OFF 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 lndicate.North Town of South Windsor
No.cuts
v .
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
See ct"tl 0i C, 14 S K e 14\ Est.Patch Unit Price
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price
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 OUTLINE
/D�IN/THE TOWN OF SOUTH WINDSOR'S STREET C.UT PERMIT MANUAL.
Signed: Y ff�'� Date:
Title: I Co sl'--hu -r O h Tec 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 Permit 08 REV 10-22-08
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