HomeMy WebLinkAboutStreet Cut Permits 11 Stonefield Trail (2) 1300211 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 08/07/2013
GIS ID: 86100011 = /�% „ FEE: 0.00
MUNIS APPLICATION# 201301126 EXPIRATION DATE:
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APPLICANT LOCATION
NAME: YANKEE GAS /-: � REST lit 9TOI EFIELD TRAIL
ADDRESS: 112 PROSPECT HILL I - =
It, idJ DONALD P
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EAST WINDSOR, CT-1106 , % '�% FMNFIELD TRAIL
�JVINDSOR, CT 06074
PHONE 860-292-2242
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WORK DESCRIPTION: INS Ay C � fC1TED AT
INTEIECTIOVO ROADWAY
APPLICANT AGREES TO FURNISH THE TQ �"
VV 0�'—O3JT ' � MOI 'CIF AQ--N REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANV-EXPW IN F, �3 N R AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI` L115
.�I�I�W= A�WI��-�,ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN 0 W IaII� TIER IT MANUAL.
ISSUED BY DATSCTED INSPECTED BY
8n12013 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... i 3 {)i9 1 CONTRACTOR: ye,.n:40
LOCATION: n�-e l o" I
TYPE OF WORK:_ 1 V 16
DATE INSP NEEDED: DATE IMP; /b /
INSPECTED BY: -L
WORK IN
lot X.
AW
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
08/07/2013 WED 8: 45 FAX 860 292 2202 12002/002
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No, TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
Name of
FEE $25.OQ ca
f=irm�( ILA. Q S Phone No. U UP
Address of FirmZip Code_QL U S c,
Location of proposed work
Describe fully nature of permit requested 3-f a l l( C 0-S. —1�e � e
r''4e
Starting date Approx.time for completion__
Call Before You Dig No.,;�O 13 30-()I `?L] Existing Water Supply: Q'Public Water ❑Well
Existing Sewage Service: ❑Public Sewer [3-Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PER PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
L�ENGT-ffi-T-RAFFIG CONTROL-AND-T iE-!'GWN-S-CGt TR-ACT-COSTS-. THE-PERMANENT PA - -H-IS-TYPIGALLY
COMPLETED WITHIN-A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR
Show sketch of proposed work or fumfsh
two copies of separate drawing This section to be filled out b
Indicate North Town of South
h VV_indsor
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
i Est.Patch Unit Price$ /sf
Est.Patch Cost
t U c.(. �C,..S Se.ry 1 Est.Curb Replacement
Q u�. ft
Est_Curb Unit Price$-/ft
1 Est.Curb Cost$
"J
Est_Traffic Unit Cost$ -1/hr
Est.Traffic Control$_
Amt,of Deposit$
Jam'
Total Due$
)Cash ( )Check#
Applicant is responsible for contacting Paid B
the Police Dept.and C.B.Y.D. y
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 UTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: �atl Date:-44 3
Title: -� Y� Q ' C 10-4 , 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