HomeMy WebLinkAboutStreet Cut Permits 582 Chapel Road (2) ------------------------ --------
1400322 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 11/05/2014
GIS ID: 18000582 FEE: 0.00
MUNIS APPLICATION# 201401603 EXPIRATION DATE:
APPLICANT LOCATION
NAME: YANKEE GAS ADDRESS: 582 CHAPEL ROAD
ADDRESS: 112 PROSPECT HILL RD OWNER: LEBLANC MARTHA W
EAST WINDSOR,CT 06088 582 CHAPEL ROAD
SOUTH WINDSOR, CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: EXCAVATE IN ROADWAY&GRASSY AREA OF RIEGH OF WAY TO
INSTALIA/2 INCH PLASTIC GAS SERVIE
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 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 WINDS R'S STREET CUT PERMIT MANUAL.
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ISSUED BY DAT IN PE TED INSPECTED BY
11/5/2014 3:48 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:_ �1�a,/�, e 56 4,J
LOCATION: �U
TYPE OF WORK: 1 CIS u 11 io2 y0 �-(S 1 C. CAS y i Ce-
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: Si")
WORK IN
PROGRESS: �?��Q �w CJ� r •� � {��-ve.
x 3 v- Clqs �►
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molioy/forms 2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1640 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00
Name of Firm Q'M-Ac'es Giq-S Phone No.___g� Jam'#3 292 6
Address of Firm 1/ 2, P.00s PCe- o ST ,�' • c..,.X'V sot Zip Code
Location of proposed work 5 S 2 C H,4.0 t t" /2 40 So W i.vo,tom
Describe fully nature of permit requested I.v /2.s 4-4
.vS 74 &c
Starting date----?-' '/ / y Call Before You Dig No a 0
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. TH
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut ,6 Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut o u 'VA'X
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
This copies of separate drawing
No. cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
` Est. Patch Unit Price$ /sf
Est. Patch Cost$
G Est. Curb Replacement ft
Est. Curb Unit Price$ /ff
Lt jaz
Est.Curb Cost$
s Est. Sidewalk Replacement sf
Est. Sidewalk Unit Price$ /sf
Est.Sidewalk Cost$
Est.Traffic Hours hr
l TiN` �� /�C�O
a s �''►i4 iA Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
Applicant is responsible for contacting the Police Dept:and C.B.Y.D ( )Cash ( )Check#
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 STREET T PERMIT MANUAL.
Signed: Print Name A2.**1AQ0 D1*4S0X1 Date: /6-23 �`J
Street Excava' n Permit 2014
TOWN OF SOUTH WINDSOR
ENGINEERING DEPARTMENT
ADDRESS PERMIT NUMBER
INSPECTOR TEMP. PATCH DATE
INSPECTOR COMPLETION PATCH DATE
T *
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