HomeMy WebLinkAboutStreet Cut Permits 9999 Sycamore Road (5) 1000192 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/16/10 ;
GIS ID: 88809999 FEE: 25.00
MUNIS APPLICATION# 201001234 "- EXPIRATION DATE: 09/16/11
APPLICANT :- _ LOCATION
NAME: TELE-NETWORKS ADDRESS.; SYc---DRE ROAD
ADDRESS: 31 BAKEWELL COURT = OWNER." SOUTH�VINDSOR TOWN OF
CRANSTON,RI 0292I - lSl(l SU1rLIVAN AVE
WINDSOR,CT 06074
PHONE 401-461-8420
WORK DESCRIPTION: REPI3P, E T TING ArYNO WORD INIjAVEMENT-
BOREU DERDRIV RErER
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WI�DSOR T iE AMOtN+OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED$Y TIt TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TIDE APPLICANT IS FAIv1II IAR WITH AIfl WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINI,D IN THE TOWN OF SObITH WINDSR'S STREE GUT PERIvfIT MANUAL.
ISSUED BY DATE"INSPECTED INSPECTED BY
9/16/2010 12:34 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /qc�l CONTRACTOR: Aje� tlodfit
LOCATION: ca. 1)('rf� p (ad
TYPE OF WORK:— A G'e c/-�IV
DATE INSP NEEDED: DATE INSP:. 11
INSPECTED BY:
WORK IN
PROGRESS: Lill
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: Wk- DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
r
ate/ao a.�y APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: 6 D
SOUTH WINDSOR, CT 06074
- tt FEE $25.00
Name of Firm �e JQ_ NelocjrcS Phone No. LUN- 961 L•23o9
Address of Firm &,ke-oo Il LT Cfans+ fZ Zip Code 1
Location of proposed worker 7 - 5 7 SvC cwtn rC_ �+a
Describe fully nature of permit requestedQ_� Ytp_v`,c-/�{� C A Tip
Starting date 1 W2(J/0 Approx.time for completion 1 (?a, i
Call Before You Dig No. oi0/0 3-70 15-q Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN AYEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
4— See No.cuts
Est. Patch Size(s) sf
Vt (Al,f/j 0 Est. Pvt.Thickness in.
Est. Patch Unit Price
� t �k ��,� ��l�t�� f o rr•
Est.Patch Cost$
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$ oZ�
( )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 SOUT WINDSOR FOR.ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION H THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS ,KrLINED IN E TOWN OF SOUTH WINDSOR'S STREET CUT
�PERMIT MANUAL.
Signed: Date: S`, iIT
�F-20/e)
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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