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HomeMy WebLinkAboutStreet Cut Permits 66 Paper Chase (4) 1400019 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER STREET CUT PUBLIC UTILITY DATE: 02/11/2014 GIS ID: 69000066 FEE: 0.00 MUNIS APPLICATION# 201400120 ;" EXPIRATION DATE: APPLICANT - - LOCATION NAME: YANKEE GAS Al -, ADDRESS: 66 PAPER CHASE ADDRESS: 112 PROSPECT HILL RD OWNER. MATJLI JEANNE M EAST WINDSOR,CT2{088 ," - 66 PAPER CHASE SOUTH WINDSOR,CT 06074 PHONE 860-292-2242 WORK DESCRIPTION: EXCAVATE O INSTALL GAS SERVICE - APPLICANT AGREES TO FURNISH THI;TOt©F$OUTH`WINDSaR THE AMOUNT OFD REQUIRED AND TO REIMBURSE THE TOWN OF SOUTH WINDSOR FOR A VZCPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS PERMIT AND f - APPLICANT IS FAMILIAR WITH ANC WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSR'S STREET CUT PERMIT MANUAL. 0- ISSUED BY DATE INSPECTED INSPECTED BY 5/I/201412:09PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: / YDO® / CONTRACTOR: LOCATION: (o(n P�r C.kase- TYPE OF WORK: cf v I e Q_.- DATE INSP NEEDED: DATE INSP: $/is//i` INSPECTED BY: 43 D WORK IN PROGRESS: 4 X 3 t�%"t �'1 a � CLJ -be SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO AS-BUILT: INPUT: of DATE: X'l i Y'l I S/2014 Town of South Windsor INPSEMON REPORT 14 ---A-PPLICA'I"IONTOft-STREET EXCAM41`I WP AA�IIT ---- _ - ---_.__ Appl.No. TOWN OF SOUTH WINDSOR Permit No. PUBLIC WORKS DEPARTMENT ---- ---- Date. ~� r.. r-,... SOUTH.WINDSOR,CT Q6074 . FEE $25.00 1. Name of Firm Phone No. -c�a- Address of Firm 2 Ih Zip Code Location of proposed work Describe fully nature of permit requested Starting date -(T 1 Lf Approx.time for completion i C�n Call Before You Dig No. ab 14 �����`� Existing Water Supply: ❑Public WateIr ❑Well Existing Sewage Service: ❑ Public Sewer ❑Septic PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY COMPLETED WITHIN.A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR. Show sketch of proposed work or furnish This section to be filled out by two copies of separate drawing Indicate North Town of South Windsor No.cuts Est.Patch Size(s) sf Est.Pvt.Thickness in. Est.Patch Unit Price$ /sf Est.Patch Cost$ Est.Curb Replacement ft Est.Curb Unit Price$ /ft IEst.Curb Cost$ :y Est.Traffic Unit Cost$ /hr Est.Traffic Control$ Amt.of Deposft$ Total Due$ ( )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 SVUTLINEDA THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT 11MANUAL. Signed: Date: Title: (A Driver's License M 26 w,-A:� / 14 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 r m r vl-C� 2" X HP ]984 3 43 P, 3 108` 6.2 ® � N t\ C' 6.5 0 0 1:440 1-3e.7' 73.4' z a- The material contained on this map shall considered proprietary to Yankee Title: Gas and user(which is defined as any person or entity who has received the map through U k � 0 0 sale,purchase,exchange,gift,or }ly` (666��.LV����i%% otherwise)shall keep.it in confidence and shall not furnish or disclose it to any third Party without the prior Information shown is not guaranteed and Yankee Goo assumes no responsibility. 'jO"b' The Hortheost Utilities System written permission of Yankee Gas. Contractors are urged W toll Yankee Gas for further information at t-800-999—Mu a e' — pr— 107 selden St.,Berlin CT 06037 i t { n .. e1 Ufa !un 211 X HP 1984 3 43 P 3 ® 108 r 1 f+- 6.2 ` N 0 r O 1:440 1'+3e.T 73..P W The material contained on this map Title: shall a considered r(which is to Yankee Gas and user(which is defined as any person or entity who has received the map through I a u sale,purchase,exchange,gift,or j �C•f+ otherwise)shall keep it in confidence y ¢Jl (t iii L and shall not furnish or disclose it to any third party without the prior Information shown is not guaranteed and Yankee Gas assumes no responsbitity """"'y' The Nofthelst U10ities System written permission of Yankee Gas. Contractors are urged to call Yankee Goa for further information at t-800-9 9-0g00 ate: JU—Apr-201 4107 Selden St.,Berlin CT 06037