HomeMy WebLinkAboutStreet Cut Permits 24 Chatham Lane (2) 1400081 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 05/01/2014
GIS ID: 18900024 FEE: 0.00
MUNIS APPLICATION# 201400464 ;
EXPIRATION DATE:
APPLICANT LOCATION
NAME: YANKEE GAS ADDRESS: 24-CHATHAM LANE
ADDRESS: 112 PROSPECT HILL RD" OWNER: MAJIDRUKHSANA
EAST WINDSOR,CT 8$ CHATHAM LANE
SOUTH WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: EXCAITII�IG 12'X2'VAC HOLE FOR INSTALLAfiiON OF TEST STATION
ON GAs--1MAIN
APPLICANT AGREES TO FURNISH THONTOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR,66q EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WANDS tR'S STREET CUT PERMIT MANUAL.
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ISSUED BY DA` E INSPECTED INSPE TED BY
5/l/2014 8:43 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: JyQDo S CONTRACTOR: Q
LOCATION: C 2 a03 L a 0,e
TYPE OF WORK: C AOL Ar loslard"oyon
51®iZ
DATE INSP NEEDED: DATE INSP: ix 1-7
INSPECTED BY: L t>
WORK IN
PROGRESS: //► t ` 1 t C' m�� A_� `;c
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES [-] NO
AS-BUILT:
INPUT: DATE: '1
S/2014 Town of South Windsor INPSECTION REPORT 14
- ........... ...
- A- PLt0AT101V FOR79TR ET EX A A1'IL?�i PER11iItT _.__�-----
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT y-
.1540-SL1LLIV-A�E AV NUE- Date:_
va.... :... SOUTH WINDSOR,:CT0074 .
FEE $25.00
Name of Firm ou) �6 Phone No.
Address of Firm t T Zip Code c`&Cc0
Location of proposed work
Describe fully nat re of permi requested e C
Starting date - Approx.time for completion
Call Before You Dig No. Q Existing Water Supply: ❑ Public Wat 9 ❑Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY.PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing indicate North Town of South Windsor
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
1
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
,i
Est.Traffic Control$
Amt.of Deposit$
Total Due$
{ )Cash ( )Check#
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 QtJTLINED IN TOWN OF so
UT WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
_ Date:
� �r !-2A Si'l���t Cry( / //� J
Title: Driver's License#:___ j to 6 /
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 Yankee
Gas contained hi this mop Title: / C(� m 1
shall be considered proprietary tob!—
Yankee Gas and user(which Is
defined as any persan or entity
who has received the map through r /'� o O
sale,purchase,exchange,gift,or _.}-
otherwise)shall keep it in confidence
and shall not furnish or disclose it
to any third porky without the prior Information shown is not guoranteed and Yankee Gas assumes no respansihil'dyy. •`"""'j' The Northeo'sl UtNties System
written permission of Yankee Gas. Contractors are urged to call Yankee Gas for further information at f-800-989--uu
• C e: P 107 Seklen St,Berlin CT 06037
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The material contained on
hi this mop /r1 C `"'1 ' J lam' i
shall be considered proprietary to Title: /lam'
Yankee Gas and user(which 15
defined as received
person a entity
who has received the map through
sale,purchase,exchange, gift,or y \_I ►f }(/ 1 r
otherwise)shall keep it in confidence
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 400teost Utilities System
k written permission of Yankee Gas. Contractors ore urged to Call Yankee Gas for further information at 1-800-989-090D Date: — pr- 107 Selden St.,Berlin CT 06037
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