HomeMy WebLinkAboutStreet Cut Permits 280 Strong Road (2) 1300082 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 05/02/2013 ==
GIS ID: 87000280 FEE: 0.00
MUNIS APPLICATION# 201300562jW PIRATION DATE:
40 ;�
APPLICANT
�y LOCATION
NAME: YANKEE GAS f ���ADDRES� 28
ADDRESS: 112 PROSPECT HILL RTC% (FT1NG ROAD
CARBOANEAU DANIEL J
EAST WINDSOR,CT fi 8 Af
0 MONG ROAD
PHONE 860-292-2242
JTFI INDSOR, CT 06074
WORK DESCRIPTION: KJAWS 1`xTIG GAS MAIN DUE
TO T(����01 b
APPLICANT AGREES TO FURNISH THE 1#IW�E=S(�UT �_
THE TOWN OF SOUTH WINDSOR FOR AN` EXPE � 0 ( �BQND REQUIRED AND TO REIMBURSE
�� � E T�7 N A MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH1PA � IS W1 A VCI ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN Oft( 'W ' -V' T MANUAL.
ISSUED BY DATR ED INSPECTED BY
5/2/2013 10:56 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 000 a- CONTRACTOR: YG.Y) Lca_
LOCATION:
" v
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 8 s'
INSPECTED BY:__ Qn
WORK IN
PROGRESS:— We (r�S ;.,,=crs
re loc.�z)ej Park
`D ary y �d?t 6 b.a�LP _t M I >,p y►t 1 b"o- 4c, L
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPEMON
I
APPLICATION FOR STREET EXCAVATION- PERMIT
TOWN OF SOUTH WINDSOR Permit No.
�- PUBLIC WORKS DEPARTMENT
'-' TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm `tonkee &ems-
- _ Phone No. 7-249
Address of Firm d 2-
r�5
Ir Location of proposed work 29o
r
Describe fully nature of permit requested C2
Starting date
Approx.time for completio 12
Call Before You Dig No. Traffic Services Control No.
g:
_ Show sketch of proposed work or famish
two copies of separate drawing Indicate North This section to be filled out b
Town of South'Windsor
£' Pavement Cut
No.cuts
Est.'Size of Penn.Patch(s)
Est.Pvt.Thickness In,
Est.Unit Price$
Amt.of Deposit$
5� Total Due$ b
l el
_ )Cash( ) #_.
oT�cr k�s7. Permanent Patch
GA3 .wt�n►
- - - �- - - - - - - - - -• - - - No. Cuts
Size of Patch(s)
-41701
G As Final Billing
_ L Amt.Due Payee
Ami:Due Town
fL� $
By
Applicant is re risible for contactigg
the Police Dept.and C.B.Y.D. Date
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
PERMI TLI,NEED IN THE TOWN OF SOUTH WINDS
OR'S STREET CUT PERMIT MANUAL.
Signe `3�r� �..i< <, Aa s� Datt
e:
Tifle. ..e I-
Driver's License M
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES