HomeMy WebLinkAboutStreet Cut Permits 208 Dogwood Lane (2) 1300178 TOWN OF SOUTH WINDSOR, CT
PENT NUMBER STREET CUT PUBLIC UTILITY
DATE: 07/17/2013 =
GIS ID: 28500208
FEE: 0.00
ML NIS APPLICATION# 201300983 - EXPIRATION DATE:
APPLICANT = LOCATION
NAME: YANKEE GAS / �� REST 20830( WOOD LANE
D
ADDRESS: 112 PROSPECT HILL —
/ ER GRMAI KEITH R&LESLIE A
EAST WINDSOR, CT bM0 08
��� �G�VOOD LANE
S6TTIT WINDSOR, CT 06074
PHONE 860-292-2242 -
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WORK DESCRIPTION: RPAIR A S, A
i
APPLICANT AGREES TO FURNISH THE 1`QWr�FOUTIDQIEMOUI<13 OF.130D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AA��EN3E i IG�� TIIE TOWN I R U AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH IAIF IS FA1vTI WII A #D WILE ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN O L T MANUAL.
,'
ISSUED BY ATETNS-PECTED INSPECTED BY
7/17/2013 9:22 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 01 CONTRACTOR: `f a,
LOCATION: 2 1 G 70 l'1t�
TYPE OF WORK:_ fta(z\z El ' uak
V
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN �Yf
PROGRESS: (,,-IS 2a r a` Etc
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: 1 74
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR`STREE`f-EXCAVATION PERMIT
Appl. No, TOWN OP SOUTH WINDSOR Permit No.
PUBLICWORKS DEPARTMENT-1540 SULLIVAN,AVENUE Date: 7 /* (
SOUTH WINDSOR CT 06074
FEE $25 00
Name of Firm. Phone No.
Address of S. 7 Code 0
Location of proposed work
Describe fully nature.of perm trequestedV, 4 � adg +
.Starting date / Approx dime for completion
CSH Before.You' )ig No: I o/ 5°a Existing.Hater Supply: []Public Water ❑Well
Existing Sewage Service: 0 Public Sewer ❑Septic
�PLLASE NOTE. THE d POSIT i OR THE PERMANENrt PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATIL,THE APPL-,ICANT IS RESPOMSIBLL:IFCRIHEBULL PINAL}COST.OF THE
PERMANENT PATCH AND-CURB REPLACEMENT;INCLUDINGONY INCREASES IN PATCH-AREA,CURB .
-�dt.rIQTHf TRAFFIC,CONTROL AND THE`TOWN'S:COWTRACT COSTS. THE`PgRMANENT PATCH'IS"TYPICALLY
" OMPL,ETED WITHIN AYYE14R OF'THE TEMPORARY PATCH BUT IT COULD`B6 LATER'THAN A YEAR.
Show sketch of proposed work or.fumish -s �obefllled out by
two copies of separate drawing: Indoate North T n I�ndsor
No.cuts
` Est.Patch Size(s) sf
Est.Pvt.Thickness in.
EsL Patch.Urdt Price$ ./sf
Est.Patch Cost$
Est.Curb Repiamnent ft
Est.Curb Unit Price
Est.Curb cost$
Est..Trsfriid Unit Cost.$ /hr
Est:Traffic Control$
A nL of Deposit$
Total Due$
{ )Cash O Check#
Applicant is responsible far contacting Paid By
- the Po iced :and-C:B-.Y:D. - - - -
1 AGREE TO FURNISH TO.-THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
TOWN I OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN,FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WI1H THIS PEISMIT AND THAT I AM FAMIt�1AR, WITH #NR WII L ASIDE I3Y THE RU4ES.AND REGULATIONS FOR.
PERMITS A OUTLINED IN THE OWN OE SOUTH WINDSOR'S STREET C.UT P EMIT MANUAL.
Signed: Date
Title: � � I Driver's License#•
PLEASE ALLOW AT LEASTTWO 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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