HomeMy WebLinkAboutStreet Cut Permits 9999 Kelly Road (7) 1100006 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PUBLIC UTILITY
DATE: 02/01/11
GIS ID: 49509999
MUNIS APPLICATION# 201100085 - ` FEE: 00
EXPIRATION DATE:
APPLICANT = LOCATION
NAME: YANKEE GAS
DRFifis KELLY ROAD
ADDRESS: 112 PROSPECT HILL.RD C W ER - SOUGH WINDSOR TOWN OF
EAST WINDSOR, CT 06I}88 - 154Q.SUI LIVAN AVE
PHONE 860-292-2242 = OHIN
SOR,CT 06074
pc
WORK DESCRIPTION: EXCAVAI ERST HOLES TO LOCATEIEK DEpTFI OF EXISTING GAS
MAINME A
APPLICANT AGREES TO FURNISH THE TOWI+IQF=SOUTH W---- R-- t AMOiIf 1T C}F BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANV EXPTNSES 1NCURREIj BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE 41?-E ANTIS FAMILI----- A�1b I ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S4iJTH WINDSR'S STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED ff TED BY
2/1/2011821AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:/ CONTRACTOR:—VVI � .�.
LOCATION: V' 0 7r
TYPE OF WORK: I e Ler L �S
DATE INSP NEEDED: — DATE INSP:
INSPECTED BY: J
WORK IN
PROGRESS: worz k
SEPTIC TANK PUMPED, SMASHED, FILLED Nra WITNESSED ❑ YES ❑ NO
AS-BUILT: tilA
INPUT: ( ice DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm
Ph
Address.of Firm 1.12 ` one No. �Z�Z-----
Location of proposed work 1611 p,-
Describe fully nature of permit requested kzxc-,-,
Starting date M•,rc Zola
Call Before You Dig No. Approx. time for completion 2.
Traffic Services Control No.
Show sketch of proposed V"R%or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South'W;ndsor
Pavement Cut
No.cuts
Est."Size of Penn.Patck(s)
I
EsL Pvt.Thickness in.
I Est.Unit Price$
AmL of Deposit$
Total Due$
i by
( )Cash( )Check#
_4 Permanent Patch
I No. Cuts
Size of Patch(s)
�1 (b Final Billing
Amt.Due Payee
d Amt.Due Town
- By
Applicant is re nsible for contacti
the Police De t.and C.B.Y.D.
1 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
PERMIT S O THE TOWN OF OUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed
Date:_
Title:_ ��►'��f 1_�}�,i•4cl
Drivers License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES