HomeMy WebLinkAboutStreet Cut Permits 39 Quarry Brook Drive (2) ----------------
1000216 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/07/10
GIS ID: 74100039 - FEE: 25.00
MUNIS APPLICATION# 201001374 ,,. EXPIRATION DATE: 10/07/11
APPLICAN11-fF LOCATION
NAME: TELE-NETWORKS ADDRESS: 39 71 QUARRY BROOK DRIVE
ADDRESS: 31 BAKEWELL COURT ' OVER: D RAN O KATHLEEN G
CRASTON,RI 02921 39 ,QUARRY BROOK DR
SOUTH"WINDSOR,CT 06074
PHONE 401-461-8420 - =
WORK DESCRIPTION: REPLACG ESTING CATV'BETVVLEN 39&7 i QUARRY BROOK DR
APPLICANT AGREES TO FURNISH THE TDWN -F SOUTH WM OIf TEE AMOUNT"OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXP1 NISES TNCU14MI?BY THF-TOWN F(?R MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE AP' iCANT`=IS FAME IAR, lTH ANI�WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUiH--WIND ' `STREE3 GUT PERIVIIT MANUAL.
to
ISSUED BY 7 DAT PECTED INSPECTED BY
10/7/201011:22AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
" "" _
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /000d 16 CONTRACTOR: d bo�r�.S
LOCATION:—,3 / - rI (��f ((il Al D 64_-
TYPE OF WORK: Rw Aq C `
DATE INSP NEEDED: DATE INSP: �!
INSPECTED BY: r3 b
WORK IN
PROGRESS: CFr TV L. dL-e, 9„►
0
71
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: CON DATE: 9
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT /00'd/6
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
' SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm Phone No.� c93oQ
Address of Firm 3 ' 2,a1<,,,_1 Cj e tk C cC:'I Zip Code O act 2.1
Location of proposed work 3q - f Q f,6c+t; O
Describe fully nature of permit requested 2 L A-
Starting date )01 falsolo Approx.time for completion t lDCW
Call Before You Dig N8.1}01 a q I CU i G� 7 Existing Water Supply: ❑ Public V6ter ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /st
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 SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION ITH IS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS rLINFD IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PER T ANUAL.
Signed: Date: G
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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