HomeMy WebLinkAboutStreet Cut Permits 419 Griffin Road (2) 1400342 TOWN OF SOUTH ,WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 12/05/2014 ;
GIS ID: 39000419 FEE: 0.00
MUNIS APPLICATION# 201401750 IXP IRA TION DATE:
APPLICANT , - LOCATION
NAME: YANKEE GASlRus-
ADI)E 4P� RFIN ROAD
ADDRESS: 112 PROSPECT HILL tkI 1EI� TufCHEIZZA DANTE G
ff
EAST WINDSOR, CT., 6t 88 = 4I & I IN ROAD
VT V INDSOR, CT 06074
PHONE 860-292-2242 -
WORK DESCRIPTION: EXCAVAII-T0 820k J
.. = Ail ,
APPLICANT AGREES TO FURNISH THE 10 WN OF SQUTH,W 1�II SI F�TFIE AMflC t Q�BOLD REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY R EN ES INI✓VRRED B THE TQ t I I I INTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH rAPPL CANT IS FuIl- ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF�O'UTH V�INDSOR STRICT�I IT MANUAL.
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ISSUED BY DAN&I -PAC ED INSPECTED BY
12/5/2014 3:55 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:_L1 CONTRACTOR: C
LOCATION:
TYPE OF WORK: i s S��e G,5,1A, �2 j
DATE INSP.NEEDED: DATE INSP: i 13
INSPECTED BY:
WORK IN
PROGRESS: N?<e-z CA 5 s Ser✓ 6 40 fig
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSECIFION REPORT 14
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Appl. No. TOWN OF SOUTH WINDSOR Permit No.
3-0J�®�7 PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: 1,97— ^/
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Fi Phone No.-a o -?-9 Z "22
Address of Frmj 1 2CST all( j� 3
Zip Code-VOL,
Location of proposed work LLL
Describe fully nature of permit requested Z5c C#V,)9tSrF
Ott 04 k t—o b sip &' p r J4 ou s e
Starting date_ 1 Z — j j� __Approx.time for completion
Call Before You Dig No.'Z- b 141.4(-170.o2 3L Existing Water Supply: ❑Public Water Well
Existing Sewage Service: ❑ Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT.FOR.THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT;INCLUDING.ANY INCREASES IN PATCH AREA,CURB
LENGTH;TRAFFIC:CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
'COMPLETED WITHIN-A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch bf proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate.North Town.ofiSouth Windsor
No.cuts
Est.Patch Size(s) sf
Est.PA.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curio Replacement ft
Est.Curb Unit Price
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 Dept.and C.B;Y.D.
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: Date-,
Title: C--0 U C-y' 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 �Z' g
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The material contained on this map
shall be considered proprietary to Title:
Yankee Gas and user(which is
defined as any person or entity
who has received the map through O o o fl
sale,purchase,exchange,gift,or Information shown is not guaranteed and Yankee Gas
otherwise)shall keep it in confidence assumes no responsibility. Contractors are urged to call
and shall not furnish or disclose it Yankee Gas for further information at 1-800-989-0900
to any third party without the prior The Northeast Utilities System
written permission of Yankee Gas.
Plotted:01-Dec-2014 By:grahaem 107 Selden St., Berlin CT 06037