HomeMy WebLinkAboutStreet Cut Permit 9999 Oxford Drive 1000042 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER . t. STREET CUT PERMIT
IN-
DATE: 04/05/10 t a r „6 k 4 >
GIS ID: 61809999Al
f FEE: 25.00
MUNIS APPLICATION# 201000317 xFE, RATION DATE: 04/05/11
APPLICANT 3 LOCATION
NAME: TELE-NETWORKS ()DRIVE
ADDRESS: 31 BAKEWELL COUftT% O� SOUTH WINDSOR
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CRASTON,RI 02921 � �� L,IVAN AVE
is { WINI�? DR,CT 060742734
PHONE 401-461-8420 k z ��
WORK DESCRIPTION: REPLACE E�S,������ 1
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APPLICANT AGREES TO FURNISH THE TOypTTW OND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY "ElP?o" S �I Qf(MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE AFCNIS1I IAAAND_ LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOVIASR STRBT , IT MANUAL.
ISSUED UAV DATE INSPECTED INSP TED BY
4/5/20109:23AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
a
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: e1 WAS
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 3 1 r
INSPECTED BY: I
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: L DATE: 1
W12007 Town of South Windsor INPSEMON REPORT 07
0(�I0Z)dai:y APPLICATION FOR STREET EXCAVATION PERMIT ic)000la
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
O i FEE $25.00 ¢c Q
Name of Firm 1,`� ew6 �C S Phone No. 1 - fJ pj- o 4 q- Z�b 2
Address of Firm 31 e C- r�ln I/1 12S Zip Code O Z Z k
Location of proposed work P( .
Describe fully nature of permit requested CeP -eKk�L YISCA-TV
Starting date 13"( / t'6 Approx.time for completionu
Call Before You Dig No.--�6 l OCR 2 �
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price
Est.Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt.of Deposit$
Total Due$
( )Cash (y)Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.B.Y.D.
I 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 S OUTLINED THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Si ed: Date: o
Ti Driver's License M
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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