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HomeMy WebLinkAboutStreet Cut Permits 56 Beelzebub Road (2) 1300149 TOWN OF SOUTH WINDSOR CT PERMIT NUMBER , STREET CUT PUBLIC UTILITY DATE: 06/26/2013 � GIS ID: 09000056 MUNIS APPLICATION# 201300882 � - FEE: 0.00 or Ad- � AAM EXPIRATION DATE: APPLICANT —,,� LOCATION NAME: YANKEE GAS ADDRESS: 112 PROSPECT HILL RIB _ s'` 3EZEBUB ROAD ��� IBODAU RANDALL J&ANA C EAST WINDSOR CTJOG 8 " %� Jor _ 6 LEBUB ROAD PHONE 860-292-2242 --- � INDSOR,CT 06074 AA j WORK DESCRIPTION: INSTA NA APPLICANT AGREES TO FURNISH THE TjWN l;SOUTFI. ff / �� I �E �MOI I17T Q BQ6ID REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH WINDSOR FOR ANC EPI�NSIF � �H TC� NOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND THAAJ'L11 A IS I AA WAI WI ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OPAL TFyVIN1I2' TIT_�UT pERMIT MANUAL. JJTJVi a � ISSUED BY llA 1 P✓�NSCTED INSPECTED BY 6/26/2013 11:30 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** /'jam_ =„ � ,,, TOWN OF SOUTH WINDSOR INSPECTION REPORT PEPMITNO.: CONTRACTOR: a Yl , LOCATION: 5 TYPE OF DATE INSP NEEDED. 9 DATE INSP: INSPECTED BY: B D WORK m - PROGRESS: z eNf — SEPTIC TANK PUMPED, SMASHED, FILLED_______ WITNESSED ❑ YES ❑ NO AS—BUILT: INPUT: DATE: S/FOR"/TOWN OF SOUTH WINDSOR INSPECTION 06/26/2013 WED 8: 54 FAX 860 292 2202 0002/003 APPLICATION FOR STREET EXCAVATION PERMIT Appl.No. TOWN OF SOUTH WINDSOR Permit No. PUBLIC WORKS DEPARTMENT 1540 SULLIVAN AVENUE Date: SOUTH WINDSOR,CT 06074 FEE $25.00 Name of Firm L4��. Cii Phone No.86Q a `I`6&.08,YA/ Address of Firm %/ Zip Code Location of proposed work I b Describe fully nature of permit requested Starting date_ 45YiP Approx.time for completion / Call Before You Dig No.f CJl3 a I a..3_ Existing Water Supply: ❑Public Wat ❑Well Existing Sewage Service. ❑Public Sewer ❑Septic PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURS REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB t-ENGTHi-TRAFFIGOONTR©L-AND-T4iE-TOWN-SfiONT'RACT'-GGSTS: THE-pERMANENT.PATCH-IS-TYPICALLY COMPLETED WITHIN-A YEAR OF TfiE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR. ` Show sketch of proposed work or furnish This section to be filled out by two copies of separate drawing ?', Indicate North Town of South Windsor No.cuts r -----� Est.Patch Size(s) sf I --j. ( Est_Pvt:Thickness in. I t Est.Patch Unit Price Est.Patch Cost$ I Est.Curie Replacement ft I � r j I Est.Curb Unit Price t Est.Curb Cost$ Est.Traffic Unit Cost$ ' /hr I Est.Traffic Control$ Amt.of Deposit$ Total Due$ /ZU� J nn ( )Cash ( )Check# Applicant is responsible for contacting. '&IC ._� 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 TLINED IN THE TOWN OF SOUTH WINDSOR'S STREET GUT PERMIT MANUAL. Signed: Date:112 Ttle: a. /mac- Driver's License#: PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OF PERMIT WORK MAY NOT BEGIN UNTIL A PtRMIT HAS BEEN ISSUED PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Street Excavation Permit 08 REV 10-22-08 T 5 s ;Z S�