HomeMy WebLinkAboutStreet Cut Permits 79 Wentworth Drive (3) 1300017 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 02/25/2013
GIS ID: 93300079 FEE: 0.00
MUNIS APPLICATION# 201300189YPIRATION DATE:
APPLICANT LOCATION
NAME: YANKEE GAS Af7DRESS: 9 VENTWORTH DRIVE
ADDRESS: 112 PROSPECT HILL I2I3 NER- B�LDEN- MADISON W JR
EAST WINDSOR,CT`06088 7 ' EI hWORTH DRIVE
4UTH'OWNDSOR, CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: REPAIR 'A T,JAf
APPLICANT AGREES TO FURNISH THE TOWN 6F SOUPII l id?§ E AMOtW-T OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY E PE ISES IN RRET BY'IHE TOE�I FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THIS A1?PLIGAI�T IS IvA1vJAt3 WI ICI AND WII ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN&y 6 JTH y-INDSR 9STRERT-b, P RI ITT MANUAL.
ISSUED BY DATE ISPECIED INSPECTED BY
2/25/2013 11:28 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
//
1M
sts
,- ,
ONE-
jn
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /20419 `7 CONTRACTOR: Yd
LOCATION:
TYPE OF WORK: 2 e pci R' 4Lea1C
DATE INSP NEEDED: DATE INSP: 3 Ce L3
INSPECTED BY:
WORK IN
PROGRESS:_ 5 /C ak m r �'�6
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:__ DATE: z_ _
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
,Appl.No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25 OO
Name of Frrn Phone No.
Address of Firm Zip Code
Location of proposed work
Describe fully nature of permit requested
Starting date ' l Approx.time for completion
Call Before.You Dig tVo: AO OV06 1,0 Existing Water Supply: [I Public Water ❑Well
Existing Sewage Service: Public Sewer Septic
PLEASE NOTE: THE DEPOSITFOR.THE PERMANENT:PAVEMENT PATCH AND CURB:REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB.REPLACEMENT;INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTHY TRAFFIC CONTROL AND THE TOWN'S CONTRACT-COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposedwork or furnish - This sectiain to be filled out
two copies of separate drawing : Indicate.Norlh Town.of South Windsor.
No.cuts
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
ESL-Patch-Cost ---
Est.Curb Replacement ft
Est.Curb Unit Price
Est.Curb Costs
Est..Traffic Unit Cost$ Mr
Est:Traffic Control S
AmL of Deposit$
Total Due s
,O Cash O Check#
Applicant is responsible for contacting Paid By
the Police:De t.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 THATI AM FAMILIAR WITH AND WILL ABIDE BY THE.RULE$:AND REGULATIQNS FOR
PERMITS S OUTLINED IN T TOWN OF SOUTH WINDS STREET CUT PERMIT MANUAL.
Signed: Date: ice"
Title:. �J : ! ` 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
Y \
l�
. 5
s-
6
00
s L�
41
Sl-
zz
GO
lb o
s.
�s
s �