HomeMy WebLinkAboutStreet Cut Permits 364 Deming Street (2) 1400305 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 10/09/2014
GIS ID:27600364 FEE: 0.00
MUNIS APPLICATION# 201401443 I1PIRATION DATE:
APPLICANT LOCATION
NAME: YANKEE GAS AbItE 3 b4IING STREET
ADDRESS: 112 PROSPECT HILL Y OWNER� V MUR.SRINIVAS&CHRISTINA K
EAST WINDSOR,CT Mfg AfNG STREET
= UTH VTINDSOR,CT 06074
PHONE 860-292-2242Ad i
WORK DESCRIPTION: INSTALI .flA�SERVICE FRflMHMI\ T I7h NU IZQI CUT
APPLICANT AGREES TO FURNISH THE OWN OI SOUTH WII*$D*OR`I'THE-.AMOiJIT(q $O'ID REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY P PENSES IN URED)BY THE TOWI�1 FOik MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPD,-I' IS FAMILIAR WDTH AND?WILD ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STDtE CU IEIIT MANUAL.
ISSUED BY DATE-INPIED INSPECTS Y
10/9/2014 11:36 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: IdJ2 IV
INSPECTED BY:
WORK IN
PROGRESS: 12 ,,_ 0 ,
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C- ' DATE:
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
HrrLIL;A l[Uri I-UK 5THEET EXCAVATION PERMIT
a - Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074 .�t
FEE $25:00
Name of Fi._)�p N Phone No. 86 z) -r2-4 2.- 22 5 6
Address of Firm-1 1 `2. 0-�Ds P gcy- Ul 1( C_b rp Code 0�
Location of proposed work_ 3 & + F41/ N G ,31;:
Describe f�ully nature of permit requested / A) S V—O/ �,/� 1` Isrt_ V/C 6' IF IL-x2/1
r j g
Starting date._/ 9�2 r(� Approx.time for completion_ `r.
Call Before You Dig No. 2-C, 0` -2 04 Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR-THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
.PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING.ANY INCREASES IN PATCH AREA,CURB
LENGTH;TRAFFIC:CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
'COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
-Show sketch bf proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate.North Town.of.South Windsor
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ mr
Est:Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash { )Check#
Applicant is responsible for contacting Paid By
the Polite Dept.and C.M.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:-
Title:- Lf i 0� Driver's License M ^
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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The material contained on this map Title:
shall be considered proprietary to
Yankee Gas and user(which is
defined as any person or entity t4
who has received the map through n a
sale,purchase,exchange,gift, or Information shown is not guaranteed and Yankee Gas O
otherwise)shall keep it in confidence assumes no responsibility. Contractors are urged to call
and shall not furnish or disclose it Yankee Gas for further information at 1-800-989-0900 -�
to any third party without the prior The Northeast Utilities System
written permission of Yankee Gas. Plotted:09-act-2014 By:grahaem 107 Selden St., Berlin CT 06037
SUMMIT DR.
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