HomeMy WebLinkAboutStreet Cut Permits 5 Country View Drive (2) 1400285 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 09/29/2014
GIS ID:24300005 FEE: 0.00
MUNIS APPLICATION# 201401366 EXPIRATION DATE:
APPLICANT „ LOCATION
NAME: YANKEE GAS ADDRESS: 5 COJJNTRY VIEW DRIVE
ADDRESS: 112 PROSPECT HILL RD OWNER. PATEL-OK &HITESHBHAI
EAST WINDSOR,CT OB88; =5 COITN CRY VIEW DRIVE
SOUTH WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: INSTALLGAS SERVICE ACROSS SIDE WALK NO ROAD CUT
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOhD 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 FAMII IAR WITH AND�ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR' STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
9/29/2014 2:24 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION: VI.-OW D-i N v-e
TYPE OF WORK: I/)S f s Ce. ps S 5 1 0��
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: SD
WORK IN
PROGRESS: 96?_ G:,g_s �.,�s�-ft�► �� `Serv).Le
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C_w " DATE:
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25*00
Name of Firm Y a tO 6 Phone No. O �- `2-- 2-
Address of Firm '_l 2-" �1-3 -SS r 9- t v' � r l� (Z, ) N CQ ip Code�;�
Location of proposed worker .0 C1 ► XV y j 6 U10
Describe fully nature of permit requested 1 l� S �(� is �� .S A c Z..O 9S
� 1
Starting date_--) 0.—/--/�,e Approx.time for completion
Call Before You Dig No. !L -P 3 5Y�� 1 � Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑Public Sewer []Septic
PLEASE NOTE: THE DEPOSIT FOR.THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
-PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING.ANY INCREASES IN PATCH AREA,CURB
. �LENGTH;TRAFFIC:CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BR LATER THAN A YEAR.
Show sketch Of proposed work or famish This section to be filled out by
two copies of separate drawing Indicate.North Town.of-South Windsor
No.cuts
Est.Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ Ihr
Est:Traffic Control$
Amt.of Deposit$
Total Due$
O Cash OCheck#
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. i" z6'""�
Title: 0 N i2 U A-) 77.')'C !Lf 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
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