HomeMy WebLinkAboutStreet Cut Permits 181 Graham Road (2) 1400183 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 06/23/2014
GIS ID: 37500181 _
MLJNIS APPLICATION# 201400803 FEE: 0.00
i e - EXPIRATION DATE:
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APPLICA T NAME: YANKEE GAS LOCATION
; DDRE ' IfiGIHAM ROAD
ADDRESS: 112 PROSPECT HILV R6%V_l
EAST WINDSOR, C #1RA1 EE WILLIAM T
r IKF, STREET
PHONE 860-292-2242
z %j % 9VINDSOR, CT 06074
WORK DESCRIPTION: EX �1SG� '
1IND THE CURB LINE
APPLICANT AGREES TO FURNISH THE 0)p.QIOUT1I /
AM� T-QF IOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A 30_)rV__A AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND Tl P IL- NT ISM A�� �� L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN 6P SQT7 W _TR W- -_TPER v1IT MANUAL.
ISSUED BY DIETED INSPECTED BY
6/23/2014 9:55 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
61-7 A
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /y0Uf,?3 CONTRACTOR: `�c3ndlsz�
LOCATION:
TYPE OF WORK:_ tct le a 5 49A\)l V ai►.A i lod C%zcf2� Li
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DATE INSP NEEDED: DATE INSP: 1 -? Cf
INSPECTED BY: 6-N
WORK IN
PROGRESS: /✓ ow1
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: _
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
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 $25.00
Name of Firm YamVee Gas Sc r yt ces Coe4nah�l Phone No..( ) ?St2- 2247
Address of Firm I,i 2 QPQ^s A e 6t (4, 4( 'id- L 4 sf 1Al� A r(s C-C Zip Code 0 6 G�&
Location of proposed work 19,1 G,-a GI G#- 2d
Describe fully nature of permit requested 4�K ra v_4_ fe 'to i✓I s fg &S S er v I'c P MG I e)
is h e k% A d Ne Gvr(b (I 's?e:
Starting date 3'vV%e T✓( 4 w! Call Before You Dig No 201� 2 y U 1* 2 5" 2
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN.'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN AYEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: WNo Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
W• C), Z c' � 2 I t Z. Est.Patch Size(s) sf
b U 0 Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
�C 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 I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDSOR'S'STREEET CUT/PERMIT MANUAL.
Signed: ALS.o / &� Print Name �� c�t a e( RQ kl e cg t/
'� Date: G W6�
Street Excavation Permit 2014 (6(pU) 2 q Z • 22 L(7
181
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3 � xy / x 4 6 Gas
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CBYD Locate Request (Routine) _
(CALL BEFORE YOU DIG - CT) 06/20/2014 13:17:42
37-5G YANK/G -C1 -CW -GV
-OT -SW -T5
9J'Date: 06/20/2014 Time: 13:17
Request #: 20142504252 Prev. Request #:
Latitude: 41.8490526 Longitude: .-72.5575644
Address: 181 Street: GRAHAM RD Town: SOUTH WINDSOR
Nearest Cross Street: MARK DR
Type of Work: EXCAVATE TO INSTALL GAS SERVICE.
C'Area is Marked: YES
Remarks: WORKING FROM GAS MAIN BEHIND CURB LINE TO THE SOUTH SIDE OF HOUSE.
Start Date: 06/25/2014 Start Time: 07:00
Caller: MIKE HANECAK Call Back: 7:30-4
Phone Number: (860) 292-2247 Alt. Phone:
l
Fax #: 860-292-2269 Email:
Contractor: YANKEE GAS Excavator: YANKEE GAS
Address: 112 PROSPECT HILL RD City: EAST WINDSOR State: CT Zip: 06088
Were pre-construction
..marks visible? 2(Yes No
. ........ ........ ......... ....... ......... ......... . ........ .... ..... ....... ......... ......... ......... ......... ......... . ........ . .... ..... .... . ......... ...
What facilities were marked? ❑.Main ❑ Service ❑ Both
Main facility material type? Steel ❑ Plastic ❑ Cast Iron
........ ....... .. ......... ........ . ......... . ......... .... .........
Service facility material type? ❑ Steel ❑ Plastic ❑ Cast Iron
How were the gas facilities located? ❑xQonductive ❑ Inductive ❑ Measurements
......... ....... ......... ........ ......... .. ...... ......... ... ...... ......... ......... ..... ... ..... .............. ......... ..... .....
Where was the connection made? ❑ Meter Value ❑ Test wire in box ❑ Tracer wire on service Direct connect to pipe
Did measurements match the signal? LA Y s ❑ No What was used for measurements? �<GIS X'Service Card
......... ... ...... ... I......... .
How was the area marked? ❑ Paint ❑ Stakes th
Who was the site verbal contact?11 l a
...... ...................................................................J�l. J...f.. ....... .... ...... ...... ..... ...... ......
Work completed by:
..................................................................................................................................... .. .. .............................................................................................................................. .................................................... ..