HomeMy WebLinkAboutStreet Cut Permits 108 Debbie Drive (2) 1200247 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 12/19/2012
GIS ID: 26700108 FEE: 0.00
MUNIS APPLICATION# 201201689 EXPIRATION DATE:
APPLICAN1` - - LOCATION
NAME: YANKEE GAS _ DRES IOg�DEBbIE DRIVE
ADDRESS: 112 PROSPECT HILL RD = - DER STREETR MATTHEW&KARLA S
EAST WINDSOR,CT 06988 = = = 10 SEB$IE DRIVE
S JIJTI VVINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: REPL�ICI C� �LASI EAR '
APPLICANT AGREES TO FURNISH THE TOW1�1 OF SOUTFI. ,
VDRfJRIE-AMOIJ `I'QF B�}�ID REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANC E-PENSESS�Ne-l7RI����Y TH�TDW1.11~`OR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH> APPLICANT IS FAM��AAR WI ff AN WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OFL7 H WINI3SRSTREECUT PERMIT MANUAL.
c = - -
ISSUED BY I E TNSP ED INSPECTED BY
12/19/2012 11:26 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:-1_ L_0_,�_2V 7 CONTRACTOR: l
LOCATTON IN�V/�,�h)
TYPE OF WORK: v( t lL
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: Z't,)
WORK IN
PROGRESS: repv t
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ �"ti__ DATE:
SJFORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
.Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date,
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm, Phone No.,S(Ijo A-
Address of Firm Jim Zip Code
Location of proposed work
Describe fully nature of permit requested
Starting date_j Approx.time for completion
Call Before You Dig No. D� Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price
Est.Patch Cost$
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: Date:
Title: 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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Molloy, Catherine
From: CaliCenter@CBYD.com
Sent: Tuesday, December 18, 2012 5:21 PM
To: CBYD
Subject: Locate Request-20125100996
(CALL BEFORE YOU DIG - CT) 12/18/2012 17:20:37
-5G -C1 -CW -GV
-OT 1-SW SWINDS -T5
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***** EMERGENCY *****
TIME. .16:59 -DATE. .12/18/2012
i
REQUEST NO. . .20125100996 �� +
LATITUDE. .41.8510089 LONGITUDE. .-72.5038352 E
TOWN. . . . . .SOUTH WINDSOR
ADDRESS. . .108
STREET. . . .DEBBIE DR
NEAREST
CROSS STREET. .NETSIFSKY FARM RD
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TYPE OF WORK. . . . .EXC TO RPR GAS LEAK
AREA IS MARKED. . .YES
REMARKS:
WORKING ST TO HOUSE
CREW ON SITE
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START DATE. . . . . .12/18/2012 START TIME. .16:59
CALLER. . . . . . . . . .DOUG MCPHEARSON
CALL BACK. . . . . . .7:30-4
PHONE #. . . . . . . . .860-208-6664
FAX #. . . . . . . . . . .860-292-2269
ALT. PHONE #. . . .
EMAIL ADDRESS. . .
CONTRACTOR. . . . . .YANKEE GAS SERVICES
ADDRESS. . . . . . . . .112 PROSPECT HILL RD
CITY. . . . . . . . . . . .EAST WINDSOR
STATE. . . . . . . . . . .CT
ZIP. . . . . . . . . . . . .06088
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EXCAVATOR DOING WORK. .SAME
ISSUED TO: DATE: TIME: BY:
DATE/TIME ARRIVED: TIME LEFT: COMPLETED BY:
CALL BACK: 1) DATE: TIME: BY: 2) DATE: TIME: BY:
PERSON CONTACTED: PERSON CONTACTED:
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