HomeMy WebLinkAboutStreet Cut Permits 230 Graham Road (2) 1300191 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 07/25/2013afo -
GIS ID: 37500230 FEE: 0.00
MUNIS APPLICATION# 201301045 O(PIRATION DATE:
APPLICANT LOCATION
NAME: YANKEE GAS AIHRES s, 2V 16r AM ROAD
ADDRESS: 112 PROSPECT HILL RD 0 if 'DER )kIETLI KI BRIAN C
EAST WINDSOR, CT 06
" 1fiT7LWOOD DR
QTH W NDSOR, CT 06074
PHONE 860-292-2242 --
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WORK DESCRIPTION: INSTALI11rWA 5E
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APPLICANT AGREES TO FURNISH THE TOW"F OUTH:W ID £QR TH--- OU 0 OF B0 1D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANI 'EIaJSF INI�RREI} 3X1 TOW T FAR 11INTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLI ANTjS FA I# WIT S AN4 AfLE ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SpUTI4-W bSR- TREE I.CU FpER1UIIfi MANUAL.
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ISSUED BY DATESPEI`ED INSPECTED BY
7/25/2013 9:20 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: )q J CONTRACTOR:.
LOCATION: D y,,Y
TYPE OF WORK: 1 A S`I'141
DATE INSP NEEDED: DATE IMP: 9
INSPECTED BY. t3
WORK IN
PROGRESS: 'i 00 c
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in,51,d r e5
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT.-
INPUT: Ctvl-- DATE: q h 113
S/FORMS/TOWN OF SOUTH W/INDSOR INSPECTION
07/24/2013 13:03 98602922269 PAGE 03/04
APPLICATION FOR STREET EXCAVATION PERMIT
Appl.No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: 7 9 /3
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of 1 irm CGt, ; Phone No. +�
Address of Firm "l & Zip Cado �
Location of proposed work
88—
Describe fully nature of permit requested_ ,X��,.�.-,4,,0 .� i ��4 l h { ,r.,,l' `
Starting date--.4:5/1 P Approx.time for completion
Call Before You Dig No. Gyjp'Z� Existing Water Supply: ❑ Public Wa r ❑Welt
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT"IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
tENGT-tir TftAFFIGGONTROL-AND THE417 WWSCONTRACT COSTS: T4iE.•PERMANENT.PATGH.IS-TYPICAL.L.-y
COMPLETED WITHIN-A YEAk OF THE TEMPORMY PATCH BUT IT COULD BE LATER THAN A YEAR. `
Show sketch of proposed work or fumish
two copies of separate drawing This section to be fllled out
Indicate North Town otSouth Windsor
No.cuts
Est.Patch Slze(s)_ ^s{
I Est Pvt:Thickness
in.
Est.Patch Unit Price$ /sf
I Est. Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price
Est.Curb Cost$
/ r
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
l Amt.of Deposit$
Total Dye$
( )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 UTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed_ y�,
Date:
Title: Driver's License##:
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OP PERMIT
WORK MAY NOT BEGIN UNTIL A PERMIT HAS SEEN ISSUED
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavakton Permit 08 REV 10-Z7.-OB