HomeMy WebLinkAboutStreet Cut Permits 61 Evans Crossing (2) 1100020 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 04/06/11
GIS ID: 30900061 FEE: 25.00
MUNIS APPLICATION# 201100239 EXPIRATION DATE: 04/05/12
APPLICAN P = LOCATION
NAME: TELE-NETWORKS ADDRESS: .. 61 BVAI-S CROSSING
ADDRESS: 31 BAYEWELL COURT AI Tt O LOHN M&HELEN
CRASTON,RI 029211 EVANS CROSSING
SOUTH WINDSOR, CT 06074
PHONE 401-461-8420
WORK DESCRIPTION: REPLAC 0---Aa TING-CATV --
APPLICANT AGREES TO FURNISH THE Tb-W SOUTH INDSDR THE AMOUNT OE BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY== XPENSE5 INCURRED=BY-THETOWI T FOP MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT PS FAMILIAR,Wi TIC ANI7 ViLL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SQUTH WINDSR'S STREE-T CUT PEPMIT MANUAL.
ISSUED BY j DATE INSPECTED INSPECTED BY
4/6/201111:05AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
........ _ .....
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: 2G I
SOUTH WINDSOR, CT 06074
// � JJ / FEE $25.00
Name of Firm �/e-,ve n rl,-S Phone No. $gw 3 o;�-
Address of Firm 1 &k aWe 1 j C-� (Z T Zip Code U gq1.-)- 1
Location of proposed work G 1 -6 7 )(A;
Describe fully nature of permit requested . e "h,
Starting date Q 1 Approx.time for completion 117a
Call Before You Dig No.2dl I f y0 23�L3 Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Sizes sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
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 WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS S UT NED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PER MI MANUAL.
Signed: Date: 1
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
2011 ►No�3;3 _S�9041, f�Vrjsor-
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /J Ob0c� 0 CONTRACTOR:
LOCATION: & rYD ss i y
TYPE OF WORK: 11L
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: P
WORK IN
PROGRESS: l�e.92 c C/7-T V
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07