HomeMy WebLinkAboutStreet Cut Permits 106 Natsisky Farm Roa (2) 1300019 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 03/06/2013
GIS ID: 62300106 FEE: 0.00
MUNIS APPLICATION# 201300221A ftPIRATION DATE:
APPLICANV/
J — LOCATION
NAME: YANKEE GAS �1J�DRES IBfrNA SISKY FARM ROAD
ADDRESS: 112 PROSPECT HILL3ZI - %% E = SLIRGI MARK D&MARY E
EAST WINDSOR,CT-06-0-8 1 6'A SISKY FARM R
UTI� VINDSOR,CT 06074
PHONE 860-292-2242
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WORK DESCRIPTION: REPAILAS OAK
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APPLICANT AGREES TO FURNISH THEY W DE SOUT �iD gl AMOUVT OE'B ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANC E 15I NSES-19, III% �'pW pR AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THRAI�1'L CAN IS I AMLI R W 1 AND WILT ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OOITH W SRTREF CIJT IEItiIIT MANUAL.
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ISSUEff BY DAMNg—1 TED INSPECTED BY
3/6/2013 11:3 0 AM *** PER TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: C) 1 c� CONTRACTOR:_ j a Yl blol
LOCATION: jj(p Q r6 (Z
TYPE OF WORK:_T�°.,r z;��l
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
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 Date: c s 1
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm Phone.No.
Address of Firm Zip Code /960
Location of proposed work D t el .
Describe fully nature of permit requested
Starting date Approx._time for completion
Call Before.You l5ia No: /DDd 7 / Existing Water Supply: 0 Public Water ❑Well
Existing Sewage Service: [I Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB.REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT;INCLUDING.ANY INCREASES IN PATCH AREA,CURB:
LENGTH,TRAFFIC:CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN AYEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish phis section to be filled out by
two copies of separate drawing Indicate.NoM Town.of South VVlndsor
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
EsL Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est Curb Unit Price$ /ft
Est.Curb Cost.$
Est Traffic Unit Cost.$ Ihr
Est:Traffic Control$
Amt.of Deposit$
Total Due$
)Cash ( )Check#
Appiicgrit is responsible for contacting Paid By.
the Police De t.arW C.B.Y.D. _ a
1 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 PERM AND THAT I AM FAMILIAR WITH.AND WILL ABit)E BY THE RULES:AND REGULATIONS FOR.
PERMITS TLiNED IN OWN OF SOUTH WINDSOR'S STREET OUT PE IT UAL.
Signe Date: �J
Title: Driver's L cens #:
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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