HomeMy WebLinkAboutStreet Cut Permits 67 Carson Way (2) 1000174 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/26/10 = =
GIS ID: 17600067 _ FEE: 25.00
MUNIS APPLICATION# 201001126AF dx E 'IRATION DATE: 08/26/11
APPLICANT = "- LOCATION
NAME: TELE-NETWORKS A }DRES :° 6fi_CARBON WAY
ADDRESS: 31 BAKEWELL COUNT OVM I YU HUNG YUAN&
CRASTON,RI 02921 67ARS4N WAY
OUTH WINDSOR T C 06074
PHONE 401-461-8420
WORK DESCRIPTION: REPLACTIG ESTING'CATV'
APPLICANT AGREES TO FURNISH THE TOWN- OF SOUTH'W1NDSOR T�iE AMOIJI�IT OF B(3ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCUI{RED B 'TI Ir TOWI*J FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLkANT IS FAMILIAR WI'f H Al- WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSR'S"9TREFT CUT PERlV4IT MANUAL.
GYM L E f t -f `•.
ISSUED BY DATE INSPECTED INSPECTED BY ^
8/26/201010:34AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /000/ 7 CONTRACTOR: kel e- lw�oo le_4"S-
LOCATION: ( 7
TYPE OF WORK: //1
DATE INSP NEEDED: DATE INSP: 1,112 7
INSPECTED BY: Bl>
WORK IN
PROGRESS: C,tTv L; ��� „�, /�'e l4
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: LAB DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
HNiruc;a 11UN t-UH 5 I HEE I EXGAYATION PERMIT I LW)
Appl.No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: 3 G/
SOUTH WINDSOR,CT W074
FEE $25.00
Name of Firm �%' , etS Phone No. o-, c=. 02 t � `�° L3 -
Address of Firm^'( !i C-V- C OUV C i Cut 2T Zip Code G c i Z
Location of proposed wo 7— 70 CC�1So/1 CJc
Describe fully nature of permit requested
Starting date Approx_time for completion ( C7
Call Before You Dig No. 35-00 u /`7 Existing Water Supply_ El Publiic Water Q Well
Existing Sewage Service: ❑Public Sewer ❑Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA,-CURB
LENGTH;TRAFFIC CONTROL AND THE TOWWS CONTRACT COSTS. THE.PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN.A YEAR.
Show sketch of proposed work or furnish This sect!=to be filled out bV
two copies of separate drawing Indicate North Town of South Windsor
Sep 1'1`�iC�t No.cuts
0 Est.Patch Size(sj sf
Est.Put.Thickness in.
Est.Patch Unit Price$ Isf
Est Patch Cost$
Est.Curb Replacement ff
-Est.Curb Unit Price$ /ft
Est Curb Cost$
Est.Traffic Unit Cost$ /hr
Est Traffic Control$
Arrit of Deposit$
Total Due$
( }Cash ( }Check#
Applicant is responsible for contacting Paid By
the Police Dept.and C.B.Y.Q.
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
CONNECT THIS PERMIT AND THAT I Al4I FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PER A Ot1TLI Q MI THE TOWN OF SOUTH WINQSOR'S STREET CUT P MANUAL
Si9 ned_ Date: 23 -20/0
l
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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