HomeMy WebLinkAboutStreet Cut Permits 209 Norton Lane (2) 1000215 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/07/10 =
GIS ID: 64800209 = - FEE: 25.00
MUNIS APPLICATION# 201001373 EXPIRATION DATE: 10/07/11
APPLICANT" ,LOCATION
NAME: TELE-NETWORKS ADDRESS: 209 -215 NORTON LANE
ADDRESS: 31 BAKEWELL COURT OWNER: E'ER�Us6N JOHN E&SUSAN M
CRASTON,RI 02921 - - 209 NORTON LANE
SOUTH -INDSOR,CT 06074
PHONE 401-461-8420
WORK DESCRIPTION: REPLAC G EXISTING CATV 13ETWEEN-FIaLFSE,I [J1�IBERS 209&215
APPLICANT AGREES TO FURNISH THE T6'VI OF SOUTH WM-S6 T�AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY"EXPI NSES INCURRED-45V THE-TOWN i6R MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE-- fLI�ANT`IS FAMILIAR WITH ANUWI-tL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SDUTH WIN- R'S STREET CUT PERMIT MANUAL.
V I I of 1 1 6}
ISSUED BY _ DATE INSPECTED INSPECTED
C BY
10/7/201011:18AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
......... ..
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /060a / S- CONTRACTOR: -fe le - n-%tLA-)0r�
LOCATION: 02 0 q - a l,S
TYPE OF WORK:
- Goa, c�l
DATE INSP NEEDED: DATE INSP:_i
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: - DATE:
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: 1646 2a
r SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm � �IV 2 t- Phone No.
Address of Firm t Kae-oel( C1 r ns4(M V - Zip Code 0:2cl 2
Location of proposed work a0 - Stj o r4 ,J
Describe fully nature of permit requested__'C��Dt�c�h�
Starting date d O 1 .7-0( Approx.time for completion 0,-1
Call Before You Dig No. 10 y u I D q Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing a Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est.Patch Cost$
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 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 TH T PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS A LIN D N THE TOWN OF SOUTH WINDSOR'S STREET CUT PE M MANUAL.
Signed: Date:
Title: 7 -- Driver's License M
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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