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HomeMy WebLinkAboutStreet Cut Permits 79 Hayes Road (2) 1400332 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER STREET CUT PUBLIC UTILITY DATE: 11/10/2014 GIS ID:40200079 FEE: 0.00 MUNIS APPLICATION# 201401622 EXPIRATION DATE: APPLICANT LOCATION NAME: YANKEE GAS ADDRESS: 79 HAYES ROAD ADDRESS: 112 PROSPECT HILL RD OWNER: TRUSCH RAYMOND B EAST WINDSOR, CT 06088 79 HAYES ROAD SOUTH WINDSOR,CT 06074 PHONE 860-292-2242 WORK DESCRIPTION: EXCAVATE TO INSTALL GAS SERVICE WO 8E421823 APPLICANT AGREES TO FURNISH 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 THE APPLICANT IS 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. C nu//0 A lzb;'?/,/?/ ISSUED BY DATE INSPECTED INSPECTED BY 1 1/10/2014 1 1:46AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: CONTRACTOR: t LOCATION: ` �S D TYPE OF WORK: 74Z Q S 7zet.� 3 GL-9 DATE INSP NEEDED: DATE INSP: .2- 1 INSPECTED BY: eb WORK IN PROGRESS: I s �' 2'�) C A! Serve 4- 9 c_ e_ L 4 e c: d n �- SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO AS-BUILT: INPUT: Lill'- DATE:��I1� S/molioy/forms 2014 Town of South Windsor INPSEMON REPORT 14 APPLICATION FOR STREET EXCAVATION PERMIT Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No. TOWN HALL 1640 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00 NamL of Firm rA V t CG45 S e c Ca n Phone No. o) zefZ , Z 2q Address of firm I,I 2 tnrusP,af 4{�t 1( reG�, �u W 1 nd sa Zip Code U a $ Location of proposed work 7 6Fwes Rd Describe fully nature of permit requested &—K ck yc l c -to 14 S f o l/a 4s s er^v I c e . Starting date Alp v 2a 5/ Call Before You Dig No Z G!f Y 10 31 9 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. Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut CK Curb Cut ❑ Sidewalk Cut ❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic Show sketch of proposed work or furnish Indicate North This section to be filled out by Town two copies of separate drawing No.cuts 0 Est.Patch Size(s) sf w• 6 C( 2 ( Z 3 Est. Pvt.Thickness in. Est. Patch Unit Price$ /sf Est.Patch Cost$ Est.Curb Replacement ft Est.Curb Unit Price$ /ft Est.Curb Cost$ Est.Sidewalk Replacement sf Est.Sidewalk Unit Price Est.Sidewalk Cost$ Est.Traffic Hours hr Est.Traffic Unit Cost$ /hr Est.Traffic Control$ Amt.of Deposit$ Total Due$ ( )Cash ( )Check# Applicant is responsible for contacting the Police Dept:and C.B.Y.D - PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Paid By 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 1 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: A�� Print Name m cY1 q�,l C'!Gt!1 tcy �( Date: ! Street Excavation Permit 2014 U ?ry Posed GCS S`er vi ce �J 3 'x� 'x 4 S U V T (-f VV ( A1"tJ S C�(� © C=�c c�v�►���n ► j