HomeMy WebLinkAboutStreet Cut Permits 211 Quarry Brook Driv (2) 1000234 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 11/19/10
GIS ID:74100211 - FEE: 25.00
MUNIS APPLICATION# 201001567 EXTIRATION DATE: 11/19/11
APPLICAN = - LOCATION
NAME: TELE-NETWORKS -----------------
ADRER 21;1 QUARRY BROOK DRIVE
ADDRESS: 31 BAKEWELL COURT -� 6R LC1 HENRY A&SUSAN B
CRASTON,RI 02921 - = 11: Q�JA2RY BROOK DR
-` - UtJTH WINDSOR,CT 06074
PHONE 401-461-8420
WORK DESCRIPTION: REPLAiZ4GISTG CATV
APPLICANT AGREES TO FURNISH THE TC W -F-SOUTH IDSt�RE.AMOUf7T OF BbND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANI��EXP,NSES-NCU AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPL-ft3AN`71S f L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WIIDSR S STREET CUT PEzf
MIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
11/19/2010 12:21 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
i
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /Odd CONTRACTOR: fn
LOCATION:_ 2 / Q J e, r r ci ?AY o c)
TYPE OF WORK: ..g C ' ✓/� (> 71/
DATE INSP NEEDED: DATE INSP: t/
INSPECTED BY: F57)
WORK IN
PROGRESS:__
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: �� 1
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: 1 /0
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm — 1 ►(j� Phone No.
Address of Firm 1 rc Zip Code
Location of proposed work III- 9LI �r-o k V—
Describe fully nature of permit requested �Z x ` ' Vi 0
Starting date o/0 Approx.time for completion I n�
Call Before You Dig No. 2nic)g702S,� I Existing Water Supply: El Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
e No.cuts
0 Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
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 De t.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 THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS A, _LINED THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: / /V L"d
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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