HomeMy WebLinkAboutStreet Cut Permits 556 Rye Street (2) 1200248 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 12/24/2012 ,.
GIS ID: 78600556 FEE:
MUNIS APPLICATION# 201201708 0.00
EXPIRATION DATE:
APPLICANT , �" LOCATION
NAME: YANKEE GAS ADDRESS; TREET
ADDRESS: 112 PROSPECT HILLDM SNISCALCHI CLAUDIA&
EAST WINDSOR,CI=06088 56 R '1 STREET
= SOUTHJINDSOR, CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: EXCAVATE TQ FNSTA L GAS -FRS CE
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTII'WINDSOR T31 AMOUNT OFNAD REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES 13*I URRE AY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT ISAM3LFAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOLITI- WI IDSR S STRsEET CUT PERIu1IT MANUAL.
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ISSUED BY DATE,INSPETED INSPECTED BY
12/24/2012 10:17 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: d ''I E CONTRACTOR: �a yi ICe-e,
LOCATION: �(o � e 7
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: a
INSPECTED BY:
WORK IN
PROGRESS: L±s 4
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
SJFORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FORSTREET 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 ofFrm an ee �us Se�V1ce5 compf � 22�(7
t Phone No.
Address,of Firm. l t Z: ?t a eat- Zip.Code O GAG $
Location 0f.proposed work
DeSpribe fully nature of pernift requested E vc"c a.v g C,-' s G r V ice=
Starting da#e . c� .c3t 'Z. Approx."timeforoornpietion 1 p `
Ca11 before You"Dig No. 2 O 12 5 l 0�2,.i g. " Ex atmg.1Nater Supply: 0 Pubiic Water' C1 Weil
Existing,. ewage Service; [] Public;Sewer ❑ Septic
PLEASE NOTE: THE DSPOSIT FOFI 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 LNCREASES;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.bv
two copies of separate.drawing" _ Indicate North Town of South Windsor'
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
s Est.Paton Unit Price /sf `
Est.Patch Cost$
Est:Curb Replacement. ft
Est.Curb Unit Price.$ It
Est.Curb Cost$
Est.Traffic-Unit Cost$" /hr
Est.Traffio Control$
Am;.of Deposit$
Totaf Due:$
( j Cash ( j Check#
Applicant is;responsible for contacting Paid By
the Police.De t:and C.B,Y.0 "
I AGREE.TOFURNISH 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,.jOF SOUTH WINDSOR'S STREET CUT'PERMIT MANUAL.
Signed: .�.( ��` Date: 1 2/2!
Title: Y :#Kee- CAS . pnSIlu tGh ,. 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
otreet Excavation Pennit08 REV 10-22-08.
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CBYD Locate Request Routine
(CALL BEFORE YOU DIG - CT) 12/19/2012 13:26:49
'13-5G YANK/G -C1 CW , -J1
-OT -SW -T5
Date: 12%19/2012 Time: 13,:26
Request #:, 20125101289 Prev. Request #:
Latitude: 418638141 Longitude': 72.5759773
Address: 556 Street:. RYE ST Town: SOUTH WINDSOR
Nearest Cross Street:WINDSORVILLE RD
Type of Work: INSTALLING GASH SERVICE
Area is Marked: YES
Remarks: WORKING FROM STREET TO HOUSE:
Start Date: 12/24/2012 Start Time: 08:00
Caller: MIKE HANECAK Call Back:
Phone Number: (860) 292-2247' Alt. Phone:
Fax #: Email:
Contractor: YANKEE GAS Excavator: YG/RHW/GPL
Address: 112 PROSPECT HILL R-D. City: EAST WINDSOR State; CT Zip: 06088
Were pre-construction marks visible? ❑ Yes ❑ No
- �._ ...r..,.. ........�....� _� _._ .._._�..__�.- _ ._._. �___�_ -_ _. _�__..__....�...... .�.... ._......_. _._._�.__...�.................. .._ _.................
w..��...._..�.� �.w.._..........._...
What facilities were marked? ❑ Main ❑ Service ❑ Both
Main facility material type? ❑ Steel ❑ Plastic ❑ Cast Iron
Service facility material type? ❑ Steel ❑ Plastic ❑ Cast Iron
How were the gas facilities located? ❑ Conductive ❑ Inductive ❑ Measurements
__. ._. w_.__._� _.._........ _.._......._._ . ....._ ..... _.........._ .__..........._ ._...................._._._......_ ......__........_-w. .. _.__......... _.._.._.. __. ..__ .......... ....... .....__............._......._
El .. .........
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
._ ..._..._.__...__..._......._...�_._,_.. .w,_.�.. _�.�..�.._ ._ _. �._._. ��.._.. .�� _. _..� ...�.._�.. _....�.�. .� ..__ ._� ......_.......................w _.._......._... ....w..............................._._...._....
How was the area marked? ❑ Paint ❑ Stakes ❑ Both
Who was the site verbal contact?
Work completed by: