HomeMy WebLinkAboutStreet Cut Permits 499 Rye Street (3) 1400179 TOWN OF SOUTH WINDSOR CT
PERMIT NUMBER ,
STREET CUT PUBLIC UTILITY
DATE: 06/19/2014
GIS ID: 78600499 ,
MUNIS APPLICATION# 201400777 = FEE: 0.00
q PIRATION DATE:
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APPLICANT LOCATION
YANKEE GAS �� � �� ADDRE
ADDRESS: 112 PROSPECT HILL %j/ice R STREET
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TAN DONNA L
EAST WINDSOR, C Q618 "
ftY STREET
/ — �UTH INDSOR CT 06074
PHONE 860-292-2242 t - - -
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WORK DESCRIPTION: EXd l
A 'TI���� �����I✓'
PAVVIV R XPOSE&RAISE
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APPLICANT AGREES TO FURNISH THEE
� AM IE F R3DND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH IS PERMIT
FOR AID �N R �I I� � ORAAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND Tl APICAIT Igo WL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO WNR SD7TI4DTRT OTPEIIT MANUAL.
ISSUED BY D�' 'TED PECTED BY
6/19/201411:17AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: l`J 0017 9 CONTRACTOR: !�O o Von
LOCATION: �J 9 q Q w e
TYPE OF WORK: h�al��xicA pa r rs V- ql
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: I a l g'l`�
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
---
_ -- �4PPLI��CI't01�1 FOR STREET`-EXCA-VAT N--PERMIT --
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
_. 1540...SULLIVAN-AV/CgNUE ---_ Date:
SOUTH WINDSOR,CT:,=.74. _
_:..
FEE $25.00
Name of Firm LeP Q- GlbA Phone No.
Address of Firm ( Zip Code 0 bf_
Location of proposed work
Describe full naatureof permit requested _ t ,L ! Y UK
Starting date `3 0-1 Approx.time for completion
Call Before You Dig No. 201 y VID Sit Existing Water Supply: ❑Public Water ❑Well
( Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'$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 draw' Indicate North Town of South Windsor
No.cuts
Est.Patch Size(s) sf
j Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
-i
Est.Curb Replacement ft
Est.Curb Unit Price$ /ff
i
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant is responsible for contacting Paid By
the Police De t.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 T TOWN OF SO H WINDSOR'S STREET CUT PERMIT MANUAL.
Signed�_1,� 0_�� Date:_ --
Title: �'0�'f 6} ) ch n►G C�LYI Driver's License#: W o @L ! D
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPUCATION 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
hi this map Title: 1 1 ��y,. �S-Y1 1 n yi ia- r•+{ F51�
shall be considered proprietors m �i6- �)v` ' 11 �I v , t��11 t✓
Yankee Gas and user(which is
defined as any person or entity
who has hose,a the mop through _r 1 � \_ S
sale,purchase,exchange,gift,or \J \3 R a a
otherwise shall keepp it in confidence
and shall not fumish or disclose it
to any third party without the prior information shown is not guaranteed and Yankee Gas assumes no responsibility. -O'"N'
written permission of Yankee Gas. Contractors are urged to call Yankee Gas for further information at i—aoo-989—osoO G e: — un— The Northeosl utiilies system
107 Selden St.,Berlin CT O6037
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The material contained on this map %�
shall be considered propriety to Title:
Yankee Gas and user(which 1s � �L� ^il A"� so
defined oe ony person or entity (`,J
who has received the map through
sale,purchase,exchange,gift,or C�rv—� 0 0
otherwise)shall keep it in confidence JJJ 1+� 1 I 1
and shall not furnish or disclose it
to any third party without the prior Information shown is not guaranteed and Yankee Gas assumes no responsibility. """`°' The Hortheosl Utilities System
written permission of Yankee Gas. contractors are urged to coil Yankee Gas for further information at 1—800-989—09001 a e: —Jun— y
107 Selden St.,Berlin CT 06037
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