HomeMy WebLinkAboutStreet Cut Permits 25 Paper Chase (3) 1400036 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 03/19/2014
GIS ID: 69000025 FEE: 0.00
MUNIS APPLICATION# 201400257 - IXPIRATION DATE:
APPLICANT
M5 LOCATION
NAME: YANKEE GAS Ink
ADDRESS.` 5 PACER CHASE
ADDRESS: 112 PROSPECT HILL 4WNR SMALL JOHN W&NANCY J
EAST WINDSOR,G�T�f�&8 2 ' AIR CHASE
WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: EXGNVA-TE4_�_TvO REPLACE GAS
APPLICANT AGREES TO FURNISH THRTO I OF SOUTH VINDS(?R3 HE AMA TNT OF OOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR W&PP1iES TI�ICURRETj BY THE TOWI�I I OIMAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TEE APPLICANT_IS FAMILIAR VITH AdD V LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN CIF SC)tITH WINDSI ' STREET CUT PERMIT MANUAL.
ISSUED BY DAT SPECTED INSPECTED BY
3/19/2014 7:58 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:
TYPE OF WORK: :t?2
DATE INSP NEEDED: DATE INSP: 131
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ DATE:
W/2007 Town of South Windsor INPSEMON REPORT 07
: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 $�5.00 IMP r qz�
Name of Firm a9 N V,k 76-(7h S Phone No. 2,j z — 2'Z
Address of Firm_/_r_2, e(L-C) is L-7, H t LI 12,b Zip Code 0
Location of proposed work P plc rz, U ► s,�� _
Describe fully nature of permit requested X C-A VY-9t 7—ff V"'u 6 F i?L.4 C-1F CTA- S
Starting date_ 3 -"� / --//f Approx.time for completion
Cali Before You Dig No. ZQ d l ().11 Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING.ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
i
I Show sketch of proposed work or furnish This section to be filled out by
f two copies of separate drawing Indicate.North Town.of.South Windsor
No.cuts
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Page$ /sf
Est.Patch Cost$ _
Est.Curb Replacement r ft
' Est.Curb Unit Price$ /it
Est.Curb Cost
Est.Traffic Unit Cost$ /hr
�K yQ Est.Traffic Control$
I. Amt.of Deposit$
V^ 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 AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: ' 3
Title:.�-2 A) S;;�-(2_ Lt�-�/ °� C 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