HomeMy WebLinkAboutStreet Cut Permits 57 Sycamore Road (2) 1000223 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/26/10
GIS ID: 88800057 = FEE: 25.00
MUNIS APPLICATION# 201001452 EXPIRATION DATE: 10/26/11
APPLICANT lk LOCATION
Sl
NAME: TELE-NETWORKS CAMORE ROAD
ADDRESS: 31 BAKEWELL COU-1
OW+IER H RDNIEL P&CYNTHIA M
CRASTON,RI 029217 SXCAMORE ROAD
Is I
FTFI WINDSOR,CT 06074
PHONE 401-461-8420
WORK DESCRIPTION: REPIt &I I TIN(J CATV
APPLICANT AGREES TO FURNISH THE 1VVOFOUTH5 E AMOLIN3 OPjND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANEXPEN CU��THE 1 OWN I?DI :IvIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE"--APpT�AN`I is FANRLIAR WITH AID W1LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OfiTH WND ' ." TRE)y 1 CUB PT<IIIv1IT MANUAL.
ISSUED BY DATE"INSPECTED INSPECTED BY
10/26/2010 11:43 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: AM CONTRACTOR: _1640-
LOCATION: S7
TYPE OF WORK: i0
JV
DATE INSP NEEDED: DATE INSP: I �I
INSPECTED BY: Pam_
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: - DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT .
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: /O
hz(2,1/
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm 'T le Phone No. `6u S�- a 3 a
Address of Firm l 1t C 0 rrn2:t Zip Code 09-G 9 I
Location of proposed work r-Q V-0
Describe fully nature of permit requested 2 ` 'n �V
Starting date4��c
�o/ Approx.time for completion
Call Before Y No. Vic?/0 Q 4 a 7® Existing Water Supply: El Public Ater El Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Sizes) sf
Est. Pvt.Thickness in.
Est.Patch Unit Price$ /sf
Est.Patch Cost$
Est.Curb Replacement It
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 SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTIO WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS UTLI D IN THE TOWN OF SOUTH WINDSOR'S STREET CUT P 'RMIT MANUAL.
C-41./1k
Signed: Date: 2
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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