HomeMy WebLinkAboutStreet Cut Permits 9999 Sycamore Road (4) 1000192 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/16/10
GIS ID: 88809999 ` . FEE: 25.00
MUNIS APPLICATION# 201001234 IXPIRATION DATE: 09/16/11
JJ
APPLICANT LOCATION
NAME: TELE-NETWORKS f ADDRESS,;` 9YACAIVMORE ROAD
ADDRESS: 31 BAKEWELL COURT OWNER:" SOUTHWINDSOR TOWN OF
CRANSTON,RI 0292 = = = 1546-SuIILIVAN AVE
OUT WINDSOR,CT 06074
PHONE 401-461-8420 = =
WORK DESCRIPTION: REPLACE EWI5'TING CW 'eN WOI IN AV IVTENT
BORRU 3DER I) T EWA S 37 TO 5-T&Y-6 I SR DR
APPLICANT AGREES TO FURNISH THE TOWN OF SOifTH WIN__ --TR AMOI�NT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES Ii`TCURREb BY THE TOWN v&m INTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TIDE APAL-16 FAANT IS dEP&WITH AI?iD WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOT TII WINDSR'$-STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
9/16/201012:34PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: �c� CONTRACTOR: Ao poc)(—,
LOCATION: Cf` GCt. ��( ( oad
TYPE OF WORK: llvu- C'A 4-1 V
DATE INSP NEEDED: DATE INSP: g
INSPECTED BY:
WORK IN
PROGRESS: (A71
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: IPA DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
ate/ao �a 3y APPLICATION FOR STREET EXCAVATION PERMIT
l Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: 6 D
SOUTH WINDSOR, CT 06074
- 11 FEE $25.00
Name of Firm -ere le- NP_-�c�c9 c S Phone No. L921- W) 30 9
Address of Firm &ke-�,e I{ Lr 7 C r4,35-F� Zip Code C��y� I
Location of proposed work_-A'? - 5 7 SAC mac,r-e— A,-
Describe fully nature of permit requested_le ao?r. tPv-c-Aki,. CA TV
Starting date 1 d / Approx.time for completion I tea. i
Call Before You Dig No. `3, 76 157q Existing Water Supply: ❑Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
See- A46zcked No.cuts -
Est. Patch Size(s) sf
<r 1 H� o f v�d/�i ✓ /v 0 Est. Pvt.Thickness in.
Est.Patch Unit Price
�1 O!p rr
/ Est.Patch Cost$
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 ( ) 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 SOUT WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION H THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS LINED IN E TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: SP�tf t?j. 20/()
Title: Driver's License#:
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OF PERMIT
WORK MAY NOT BEGIN UNTIL A PERMIT HAS BEEN ISSUED
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Street Excavation Permit 08 REV 10-22-08
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