HomeMy WebLinkAboutStreet Cut Permits 312 Deming Street (2) 1400320 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 11/05/2014
GIS ID:27600312 FEE: 0.00
MUNIS APPLICATION# 201401600 EXPIRATION DATE:
APPLICANT LOCATION
NAME: YANKEE GAS ADDRESS; 312 DEIIING STREET
ADDRESS: 112 PROSPECT HILL RD OWNER: CARON LIMBERLY HOLLAND
EAST WINDSOR, CT-06088 = 3�� DE1V��NG STREET
SOUTH WINDSOR,CT 06074
PHONE 860-292-2242 "
WORK DESCRIPTION: EXCAVATE ROADWAY TO INSTALL 112 INCH PLASTID GAS SERVICE
APPLICANT AGREES TO FURNISH THE`)OWN OF SOUTH WINDSC R THE THE AMOUNT Off'BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY.k l -ENSES INCURRED BY TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECT]ON WITH THIS PERMIT AND THKAPPLICANT IS FAMILIAR WITH AND WILE'ABIDE BY THE RULES AND REGULATIONS
FOR PERIVI ITS AS OUTLINED IN THE TOWN OP SOUTH WINDSOWS STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
11/5/20143:031'M *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:J 6 CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: « 3
INSPECTED BY: 3�
WORK IN
PROGRESS: Y, l
reA
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: CA- DATE:_
S/moiloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00
Name of Firm Al",-,F'6' G-"S Phone No.
Address of Firm // 2 PdZ vs r T s T f- w°n.w.5 0 Zip Code a 6 0 8
Location of proposed work 3 s 7-
Describe fully nature of permit requested 6\-c-4 a,*7-z 2 0-,;k-'0
262 /Nc /-", G 9S S e0t ale '
Starting date //—//- / y Call Before You Dig No o y s y y 2 o 2-
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut 13-Aplavement Cut CR""Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing 3 1
\° No. cuts
/
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
IA2o Aos(�a QRS Est. Patch Unit Price
SER VrG[� Est. Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
Est.Curb Cost$
/N G° S 1 I Est. Sidewalk Replacement sf
Est. Sidewalk Unit Price
C9CisTinr� GA s M$,nI Est.Sidewalk Cost$
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 I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDSOR'S STREET C PERMIT MANUAL
Signed: Print Name 4/Z�✓gvn J'0M.'yS0.0 Date:
Street Excavati Permit 2014 S 2 C-I s