HomeMy WebLinkAboutStreet Cut Permits 8 Paper Chase (4) 1400041 TOWN OF SOUTH WINDSOR, CT
PENT NUMBER STREET CUT PUBLIC UTILITY
DATE: 03/27/2014
GIS ID: 69000008 FEE: 0.00
MUNIS APPLICATION# 201400287 = -
XPIRATION DATE:
APPLICANT LOCATION
NAME: YANKEE GAS ADDRESS: 8 FAPR CHASE
ADDRESS: 112 PROSPECT HILL R3` O�yNER CH ER
MA MOHAMAD
EAST WINDSOR, CT08 I APR CHASE
ak
SIJTIWINDSOR,CT 06074
PHONE 860-292-2242 =
WORK DESCRIPTION: EXtAV'ATE OUS TO INHRTtS SERVICE
may-
APPLICANT AGREES TO FURNISH THL OyLV OF SOUTI D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYTXPENSEFFS._3RREII$Y T IE I<SWItiI FOIE MAINTENANCE OR REPAIR WORK IN
APPLICAINNT ISFAMf-- AR WITI AND WILL ABIDE BY THE RULES AND REGULATIONS
CONNECTION WITH THIS PERMIT AND TH
FOR PERMITS AS OUTLINED IN THE TO OW OF SOUTH TNDSRs&-STREET BUT PE MIT MANUAL.
ISSUED BY DA INSPECTED INSPECTED BY
3/27/2014 10:04 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:_l yOd_ h yl CONTRACTOR: �,�Ue
LOCATION: Ja:��
TYPE OF WORK:��X c;az_b 4:y- 1/4om uaL hocis,�
DATE INSP NEEDED: DATE INSP: /
INSPECTED BY: C ,
WORK IN
PROGRESS:
1Qe�'l�C� �v,,� Gas �e✓vim
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: _ � DATE:
W/2007 Town of South Windsor INPSEMON REPORT 07
i
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 $25.00 U J� �F 1-07 4PY
Name of Rrm 1�Lr. �cS' Phone No. 00 Z) Z 2 ^22 cg
Address of Firm cS P!!' C- Zip Code 6 C7
Location of proposed work r? 1 .
Describe fully nature of permit requested F12,n M CO C 1% '�4'J143U S
Starting date Approx.time for completion L
Call Before You Dig No. Lot ( 3,0-z'C>'68 Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR.THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT;INCLUDING.ANY INCREASES IN PATCH AREA,CURB
LENGTH;TRAFFIC:CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
-COMPLETED WITHIN-A-YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
-Show sketch of proposed work or furnish This section to be filled out by
two copies of separate-drawing Indicate.North Town.of.Srltrth Windsor
No.cuts
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ fsf
Est.Patch Cost$
Est.Curb Replacement it
Est.Curb Unit Price$ /ft
Est.Curb Costs
Est.Traffic Unit Cost$ !hr
Est:Traffic Control$
Lo Q t-K �•Te amt.of Deposit$
Total Due$
)Cash { j Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.&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/ASS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: .3
Title: C O A) J'V-9,U L am
%D N 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