HomeMy WebLinkAboutStreet Cut Permit 3660unk Gorski Drive 900054 TOWN OF SOUTH WINDSOR CT
PERMIT NUMBER
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STREET CUT PERMIT
DATE: 05/22/09
GIS ID:36609999
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FEE: 25.00
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aA` 05/22/104
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NAME: aa �*� va°° vuvv ��5��,y`��w( w�w�,', �� „ ( LOCATION
TELE—NETWORKS
ADDRESS: 31 BAKEWELL CO ��"" ` `\� RIVE
kili CRASTON RI 02921 °vv � ESOUTH WINDSOR
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PHONE �� �� \�aHvuv".� � R CT 0607427
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APPLICANT AGREES TO FURNISH THE TOE ampv �' v �v ov�,A ��\� aG� ��0" 14il
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THE TOWN OF SOUTH WINDSOR FOR ANY �. � a I � m w�'�! ``� OND REQUIRED AND TO REIMBURSE
CONNECTION WITH THIS PERMIT AND THE "' "`�"�"LI °\ vR,w,,v 0 MAINTENANCE OR REPAIR WORK IN
FOR PERMITS AS OUTLINED IN THE TOWN OF SO WILL ABIDE BY THE RULES AND REGULATIONS
h\uia amn\ma\\e 1 ERMIT MANUAL.
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ISSUED BY DA E INSPECTED INSPECTED BY
5/22/20099:46AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: al ( OS f CONTRACTOR: -
LOCATION: G
TYPE OF WORK: 1 5A --R-e CAL �i 7 V
---- -DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
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. INPUT: DATE:,_
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W/2007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT _q,000yq
Appl. No. TOWN OF SOUTH WINDSOR Permit Now
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firn 1l t'o- oe+w or rs Phone No. ' ` 4�' 2-S 2-
Address of Flrm__�_j 60,Keiwe l C-�, CYav1 S A Gt't Zip Code t;Zvi 2 t
Location of proposed work �5
Describe fully nature of permit requested �Y�S--tvxk` ,lcepLace C'ctty
Starting date C5 'v Approx.time for completion 1 O�2:`1
Call Before You Dig No. JOCcl(664-13(
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. ,THE PERMANENT PATCH IS-TYPICALLY
-COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or fumish
two copies of separate drawing This secSon o be filled out by
t Indicate North Town of.South Windsor
,3p e aA+a(best No.cuts
Est:Patch Sizes) sf
Est.Pvt.Thickness in.
Est.Patch'Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$. /it
EsL Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control s.
Amt.of Deposit$
Total Due$
( )Cash ( )Check#
Applicant Is responsible for contacting Paid By
the Police Dept and C.S.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 REGULATIONSFOR
PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
ig Date: �5 -1
e: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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