HomeMy WebLinkAboutStreet Cut Permits 782 Pleasant Valley R (2) 1400277 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 09/19/2014
GIS ID: 72900782 FEE: 0.00
MUNIS APPLICATION# 201401324 EXPIRATION DATE:
APPLICANT -- LOCATION
NAME: YANKEE GAS ADDRESS: 782 PLEASANT VALLEY ROAD
ADDRESS: 112 PROSPECT HILL R17 OWNER: KHAN RAHANA R
EAST WINDSOR, CT 06088- 782 PL ASANT VALLEY
SOUTH INDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: INSTALL=GAS SERVICE
APPLICANT AGREES TO FURNISH 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 MA- INTENANCE 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 WINDSOR'S�TREET CUTPERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
9/19/2014 3:45 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: L�0 a J 7 7 CONTRACTOR: 1,
LOCATION: Sc n t _/ ,P , f
TYPE OF WORK: `IS
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 6
WORK IN
PROGRESS: Alamo a S4 p `t
61n.
A Iry
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSECHON REPORT 14
A CA O O S XC VA O
.Appl. N.P. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1640 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $254,00
Name of Firm, N K EL'6,6 3 Phone No.
Address of Firm `�- ' P EQ3 2!sue Or Idlift RD Zip Code C-8
Location of proposed work "- P L CA 3 P/JT 09- ZL.0
Describe fully nature of permit requested L)CC 11ra '' -,m, r/ Gh I � �-.�1/�
T7[�bM 0Cf-OILS - 'rtj-Z" V-r,,JE E'L
Starting date 'J r I? '�/ Approx.time for completion
Call Before You Dig No. *2 a ;F ! 2 Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING.ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or fumish This section to be filled out by
two copies of separate drawing . Indicate North Town of South Windsor
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
I
Est. Patch Unit Price$ /sf
Est.Patch Cost$
` Est.Curb Replacement ft
l l Est.Curb Unit Price$ fit
Est.Curb Cost$
f
Est..Traffic Unit Cost$ /hr
Est:TraNio Control$
Amt.of Deposit$
Total Due$
)Cash O 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 OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: C%�-.c,� �L /L -'�,,^_-r Date: 'J "'"� —
Title: � �- / (�, j C f0`c 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
776
782
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PLEAS&T VALLEY ROAD
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