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HomeMy WebLinkAboutStreet Cut Permits 1020 Pleasant Valley (2) 1300294 TOWN OF SOUTH WINDSOR, PERMIT NUMBER C T STREET CUT PUBLIC UTILITY DATE: 11/20/2013 GIS ID: 72901020 - MUNIS APPLICATION# 201301731 = FEE: 0.00 EXPIRATION DATE: APPLICANT - NAME: YANKEE GAS = - LOCATION ADDRESS: 112 PROSPECT HILL RD AI2IKES IO204'LEASANT VALLEY ROAD EAST WINDSOR, CT 66b918 OWNER FRITH JQHN " 1$RU_BY`ROAD PHONE 860-292-2242 1 gm IIIARL11OROUGH,CT 06447 WORK DESCRIPTION: YANI E GARS W-W= SSj GAS SBR`VJCE APPLICANT AGREES TO FURNISH THE TOWN OF S0-UTH" '- s W?AMOUNT OF gDI�D REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH WINDSOR FOR AIRY E PENSES INC �DOV.TFIE�'1.OWI ' 0 MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND THE APPLICANT ISM1LIA WITH A1D=WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN bE S fIJ�H JNDSRs E I UD PE I MANUAL. ISSUED BY DATE INSPECTED INSPECTED BY 11/20/20131:11 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** -,. TOWN OF S0UTH WINDS0R INSPECTION REPORT PERMIT NO.: /3Ly)�,q y CONTRACTOR: , Gr LOCATION: 1 arg7- J 1 TYPE OF WORK: ` 'j N� DATE INSP NEEDED: DATE INSP: INSPECTED BY: 17>� WORK IN - PROGRESS: x �e('ti l tT 5 5r'►° SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO AS-BUILT: INPUT: DATE: -)-o a'."J200?;3.V; o�So - yil fSQr TjIPJF�7l, REPOP,107 11/07/2013 THU 12: 20 FAX 8610 292: 2202 00'05/Q06 dolL'71 APPL[GAT[O[V FOE .STREET:EXCAVAI`ION PERNC[T i3oaa�ay AppG No. T16 WN OF SOUTH WINDSOR Permit Nc. . PUBLIC WORKS DEPARTMENT 7546 SULLNAN AVEkuE Date: I� SOUTH WINE3SOR,;CT 06t)74 � : ,,// FEE �25.00 �;f Narne of Firm , r ! XG�►t ,t � 5 Phane Na.; 3" Address of Firm -�/ �G�f1 'kyL AL4 Zip Cade O/�5 1 Location of proposed work. z dr l "z Describe fully;riature of permit requested f Starting date d Approx.time for cornpleti©n ¢ Calf Before You DIg No. . 01� we Existing Water Supply: Pu61ic Water Facistrng Sewage Service: E`t'ublic Sewer ❑Septic PLEASE NOTE- THE DEPOSIT FORTHE PERMANENT PAVEMENT PATCH AND GURB REPL.AGEMENT IS A PRELIMINARY:ESTIMATE. THE APPLICANT IS RESPONSi13LIE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURE REPLACEMENT,INCLUDING'ANY INCREASES IN PATCH AREA,CURB LENt T I;�'R,i4hFIC-.GON�'Rt ANt] flE T1�tIVN s_ -boNT_ftA0T_.G SST'$ THE-PERMANENT PATCH lS TYPICA�L1' -COMPL ETED 1NM,VN A YEAR OF TfiE TEIIIIPORAttY PATCH BUT IT COULD BE LATL=R THAN A YEAR. Show sketch of proposed work or furnish This section to be4[ed�out by two copies of separate awing Indicate North Tovtrn-of South Vtiindsor t j d Z D No.cuts Zo' Est.Patch:Size(s) sf i Est.Pvt:Thickness in. Est.Patch Unit Price$ !sf Est,Patch Cost i Est.Curli Replacement Est.Curb Unit Price$ /it Est.Curb Cost$ Est.Traffic Unit Cost$ thr Est.Traffic Control$ Amt.of Deposit$ Total Due'$ ( }Cash ( }Check# Applicant is responsible for contacting. Paid By the Police Dept-and C.S.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 WELL ABIDE BY THE RULES'AND REGULATIONS FOR PERMITS AS OUTLINED IN T E TOWN OF SOUTH WINDSOR'S STREET CUT PE MIT ANUAL. Signed: Lei Date: Tide: Driver's License#f: - PLEASE ALLOW AT LEAST IWO 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 09 REV 10-22-08 i 1 Jt! I