HomeMy WebLinkAboutStreet Cut Permits 9999 Kelly Road (4) 1200036 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 04/03/12 "
GIS ID:49509999 FEE: 00
MUNIS APPLICATION# 201200327 EXPIRATION DATE:
APPLICANT" ;, = LOCATION
NAME: YANKEE GAS ADDRESS;" KE Y ROAD
ADDRESS: 112 PROSPECT HILL RD OW1ER ' SOUTH WINDSOR TOWN OF
EAST WINDSOR, CT 06Q88 1540"SIJLLIVAN AVE
== SQUTH WINDSOR,CT 06074
PHONE 860-292-2242
WORK DESCRIPTION: RELOCATE GAMAINE WEEN WILLOW STYc St�VH WINDSORNERNON
TOWNL NE REI LA01 MI Q IBM& Cs-E KEI LY RIj RECONSTRUCTION
APPLICANT AGREES TO FURNISH THE TOWN OF--SOUTH WfWSf R THE AMOUNT O1 BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPtAE$INdlURREI?$YTHE TOWN FqR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE"*_PPLII AT-Is FAMI IA1i WITH ANI3 WILT ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOU'I'IT WINI7SR"--STREET-CU`I PERMIT MANUAL.
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ISSUED BY DAT_tlNSPECTED ___41
PECTED BY
4/3/201212:OOPM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: a2 OD�'6 OONTRAaol- JOL
. LOCATION: /I
�o r . - j a � 1 Vim_
'TYPE OF WORK: L Cn
:DATE INSP NEEDED: �-- DATE INSP: \Z-ti --i L
INSPECTED BY: .1JP.
WORK IN
PROGRESS:
SEPTIC TANK PUMPED,SMASHED, FILLED ti//� WITNESSED ❑YES ❑ NO
'AS-BUILT: !4J�i�
INPUT: 4 DATE: i
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm yp-r kr__-�
as�0 Z
Address.of Firm l ( Phone No.
Location of proposed work E LL
Describe fully nature of permit requested c:r�
Starting date . c�.v r pl�r� MIS( se 'A��
Call Before You Dig No, Approx. time for completion
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North Ibis%.dlon to be filled out by
Town of Soasth Yfi or
Pavement Cut
No.cuts
Est Size of Perm.Pat
z a EsL Pvt.Thickness
in.
Est.Unit Price$
Amt of Deposit$
t
. Due
Total: $ .
by
( )Cash( )Check# -
Permanent Patch
No. Cuts
``11 � j Size of Patch(s)
Fnal BM!ng
Arn L Due Payee
Amt:Due Town
By
Applicant is responsible for contactigg.
the Polioe De A.and C.B.Y.O. -
i AGREE TOFURNISH TO
S
TOWN OF SOUTH WI THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
" _ NOSOR FOR ANY
EXPENSES INCURRED By THE CONNECTION WITH.THIS PERMIT AND THAT 1 AM FAMILIAR WITH AND WILL ABN DE BY TH FOR IS RULES AND 'REGULATIONS
IN
PERMIT O INED E TOWN OF SOUTH WIN OR'S STREET CUT PERMIT MANUAL. ONS FOR
Signed.-
\ �G
ac Date:— q )7i
Title: >>"_ —y"I V-al.11--6 --
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE.AT ALL TIMES
APPLICATION FOR STREET EXCAVATION. PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm_ YA►s K Z`
Address of Firm . 1 l2 o�� i Phone No. " 7-Z i q
i 2 t L-l_ SZ.� W rW,D a�L._ i U G� fJ`-'K
Location of proposed work L_i
Describe,fully nature of permit requested vest.,,
! u r . =
Starting date _ .� r� 'i� r^ s�✓i��s
Approx. time for..om � t � Z
Call Before You Dig No. ' """'"'"""' ` L
Traffic Services Control No.
Show sketch of proposed vim or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South'Windsor
Pavement Cut
No,cuts
A Est.'Size of Penn.Paws)
a Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit$
rt Total Due$
by
)Cash( )Check#
2 Permanent Patch
��r No. Cuts
Size of Patch(s)
Final Billing
�4� �Cat�J� C�f'�:c� �?� (���<->-�,_„St/ `t��:_.�'•.
Amt.Due Payee
C�itS � � --z:....—,mac,--`�--. C,o !mac•-� �-r,� $'
Amt.Due Town
By .
Applicant is responsible for contacti
gg
the Police De t.and C.B.Y.O.
1 AGREE TOFURNISH TO
S
TOWN OF SOUTH WI THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
NDSOR 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 WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
Date:
Title:
Driver's License ff:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES