HomeMy WebLinkAboutStreet Cut Permit 9999 Clearview Drive 1000041 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
i sq.
DATE: 04/05/10
GIS ID:20709999 :' FEE: 25.00
MUNIS APPLICATION# 201000315 TION DATE: 04/05/11
APPLICAN - LOCATION
NAME: TEL - TWORKS r
° ; EW DRIVE
ADDRESS: 31 BAK,ELL COU O" SOUTH WINDSOR
CRASTON,RI 02921
r IVAN AVE
= R,CT 060742734
PHONE 401-461-8420
WORK DESCRIPTION: REPL E�S
APPLICANT AGREES TO FURNISH THE TO O OND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FORA Y -� MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE ILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SO U RMIT MANUAL.
3 It
ISSUED BY DATE INSPECTED INSPECTED BY
4/5/20109:16AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
M
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 3/1 f 1 r
INSPECTED BY:
WORK IN
PROGRESS:_r d 7'✓
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
W%2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT o
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm - +-, wC cg Phone N4.-? 2302
Address of Firm 31 'U'Lk We V CT _Zip Code 2 Z
Location of proposed work cyarwew 0C.
Describe fully nature of permit requested V-fP ie ,O-K( S+
Starting date 3- k ( Approx.time for completion , ��".
Call Before You Dig No. 0 1100 2
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or fumish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est.Patch Size(s) sf
Est.Pvt.Thickness in.
Est.Patch Unit Price
Est.Patch Cost$
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 (4Check# _
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
:PERMIT OUTLINE IN THE TOWN OF SOUTH WINDSOR'S STREET CUT
PERMIT MANUAL.
igned: Date: > <
-tle: Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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