HomeMy WebLinkAboutStreet Cut Permits 9999 Quarry Brook Dri (4) 1000191 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/16/10
GIS ID: 74109999 FEE: 25.00
MUNIS APPLICATION# 201001233 EXPIRATION DATE: 09/16/11
APPLICAN = s, LOCATION
NAME: TELE-NETWORKS ADDRESS: QUARRY BROOK DRIVE
ADDRESS: 31 BAKEWELL COURT = OWNER" r SOUTHVINDSOR TOWN OF
CRANSTON,RI 0292I .= IS40`SUT{LIVAN AVE
SQJTH WINDSOR,CT 06074
PHONE 401-461-8420 -
GEX NPA AWORK DESCRIPTION: 8 1 IN PAVEMEN_ T
BORxU DES3IRVE ANG USGTNTO SIMKA APPLICANT AGREES TO FURNISH THE TOWN OF UNT OF=BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES I JP,1tE6 BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THIy;APPI!CANT IS FAM iAit WaH AID WILT-ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S6 TH--- DSR'S STREET CUT PERMIT MANUAL.
ISSUED BY DA 1NSPECTE5 INSPECTED BY
9/16/201012:36PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /66 ® / q / CONTRACTOR: / - lveta�,"-le y
LOCATION: � �(T(t Y:;2A C2 0 J I,)4
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: /OA4
INSPECTED BY: gp
WORK IN
PROGRESS: l'/fT�/
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: U\ l DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
aol o c� ,� 3 APPLICATION FOR STREET EXCAVATION PERMIT /04O l9/
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: 6 (r
SOUTH WINDSOR, CT 06074
/ FEE $25.00
l
Name of Firm QIe. A)et o s Phone Noj 8�'5 Y( S ' 3®
Address of Firm G&Ik tjeMr Zip Code O a 12
Location of proposed work$Lf7 El t kAA-&A 2cA 71 Ov.rru6 cewlL ra te
Describe fully nature of permit requested7 E olac vtr. cex �sltw 4 CAT V
Starting date ST,:, 23/(o Approx.time for completion t
Call Before You Dig No. CIO/C 36CI Sib 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 AYEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing 1 Indicate North Town of South Windsor
5 e A4-4aC k.e4 No.cuts
Est.Patch Size(s) sf
Est. Pvt.Thickness in.
Get v�'�i�G�J k(/! 0 jo it Est.Patch Unit Price$ /sf
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$
O Cash O 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 THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS A UTLI IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: ADaterf 'S.
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
NT
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