HomeMy WebLinkAboutStreet Cut Permits 110 Graham Road (2) 1400065 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 04/16/2014
GIS ID: 37500110 FEE: 0.00
MUNIS APPLICATION# 201400386 = EXPIRATION DATE:
APPLICANT LOCATION
NAME: YANKEE GAS ADDRESS 1 f-6GRAHAM ROAD
ADDRESS: 112 PROSPECT HILL I� OWNER CRISP$RUCE E JR&KIMBERLY N
EAST WINDSOR,G�'I?� i8 = = 116GRAHAM ROAD
SOUTH WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: INSTt� 3 +�A1;SERVIG
APPLICANT AGREES TO FURNISH THI TO N OF SOUTH VINDSOR THE AMOtNt.OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AIaIY EXEENSES-INOURW-E,'D$Y THE"-Cf FFOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND f E APPLICANT IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN(F SOUTH Wi1VDSR'S STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
4/16/2014 8:23 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 7 0()06,-s'' CONTRACTOR:
LOCATION: Gi lit/}� JC (Cc�P
TYPE OF WORK:_ ser''V rC e
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: �J
WORK IN
PROGRESS: r
Ems---
'mot M� A
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:
DATE
`;'!200;To^.: n �•: `; urfn isor P'IDjF (Qi' REPORT 01
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC.WORKS DEPARTMENT
"1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm C(A V-eQ GC4.5 5e.r J►C-0 G
Co M n Phone No.(u )
Address of Firm 6 I?- 9r o"P ec't .t( A. f WfvAsc,ir _ ZIP Code Gbo f'S
Location of proposed wo 9 A. Scikh W n d s o r
Describe fully nature of permit requested Ex ca v 4 f t 23 duo 4 e c See✓,'Ce W"r K 1
Elton lc +0 6d0S
Starting date Approx.time for completion 2 TJw Y S"
Call Before You Dig No.2 d/ t 60 3 5 b Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: [IPublic Sewer []Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
TRAFFIC.CONTROL AND THE TOWNS CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
LENGTH,
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
-Show sketch of proposed work or furnish
two copies of separate drawing This section to be filled out by
( np (( Indicate.North Town of South Windsor
S-e e 4 � a c.rt e S �e+G Y1. No.cuts
Est.Patch Sizes) sf
W.G. q 2 1D 5t
Est.Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb 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 1 AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOITS STREET CUT PER/MIT MANUAL.
Signed: Date:
Title: yG ' Concf+`v(+ic"n `�eG�• 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
01L
f 0 S ��
Ser �► ce
1 S U v i 1+ W ( NO— so IR
— — — 7 AO b
L4
C-� e,,-.v ian
CBYD Locate Request Routine
(CALL BEFORE YOU DIG - CT) 04/14/2014 09:23:20
23-5G YANK/G -C1 -CW -OT
-SW -T5
Date: 04/14/2014 Time: 09:23
Request #: 20141600356 Prev. Request #:
Latitude: 41.8465889 Longitude: .-72.5579192
Address: 110 Street: GRAHAM RD Town: SOUTH WINDSOR
Nearest Cross Street: MARK DR
Type of Work: EXCAVATE TO INSTALL GAS SERVICE.
Area is Marked: YES
Remarks: WORKING FROM STREET TO THE NORTH SIDE OF THE HOUSE.
Start Date: 04/17/2014 Start Time: 07:00
Caller: MIKE HANECAK Call Back: 7:30-4
Phone Number: (860) 292-2247 Alt. Phone:
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? Yes ❑ No
....... ....... ......... ......... ......... ......... ......... .. .....................
What facilities were marked? Main ❑ Serviced Both
Main facility material type? Plastic FI Cast Iron
........ ......... ......... ........1 _.. .........
Service facility material type? ❑ Steel El Plastic [_] Cast Iron
How were the gas facilities located? Conductive Inductive Measurements
................................................. ......... ............................................ ........................................................ ......... ......... ......... ......... .........
Where was the connection made? ❑ Meter Value E Test wire in box � Tracer wire on service Direct connect to pipe
Did measurements match the signal? ❑ Yes 1 1 No What was used for measurements? GIS Service Card
....... ......... .. .... ......................................................................... .... ......... ......... ......... ......... .... ......... ............ ......... ....... .......................
How was the area marked? ❑ Paint El Stakes El Both
Who was the site verbal contact?
......... ......... ... ..... ......... ......... ..... .. ......................................................... . .............
Work completed by: