HomeMy WebLinkAboutStreet Cut Permits 220 Old Farm Road (2) 1000222 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/26/10
GIS ID: 66300220 FEE: 25.00
MUNIS APPLICATION# 201001451 E
IRATION DATE: 10/26/11
P
APPLICANT LOCATION
NAME: TELE-NETWORKS J J I DRES- h0 OL6 FARM ROAD
ADDRESS: 31 BAKEWELL COUNT OVER I�QRTAI :ARNALDO&ILDA C
CRASTON,RI 02921 fi 20 ;OI,I-FARM ROAD
` Q TFI WINDSOR,CT 06074
PHONE 401-461-8420 -
WORK DESCRIPTION: REPO G Ig, CATV
APPLICANT AGREES TO FURNISH THE TQV D OUTH,Au INI?SO'WM- AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANI EXP ICI ES"INCUI REL?BI'TIIE T -"-' R-MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE!AAlknANfi=IB FAMIi IAR WITH A ft WALL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF�UTH-w--- S STREET CUT Ph'RMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
10/26/2010 11:41 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /oOO4e'1a- CONTRACTOR: �ele
LOCATION:_ o)ao ci d ya 12 m ,Rac) d
TYPE OF WORK: C
DATE INSP NEEDED: DATE INSP: 1 INSPECTED BY:
BY: �
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
G'I d 0 1 APPLICATION FOR STREET EXCAVATION PERMITt''�
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: 02 Q
SOUTH WINDSOR, CT 06074
11 FEE $25.00
Name of Firm . -� arQc Phone No. `6F)K C)
Address of Firm ( &- eExc( 0-4 Q rt k Zip Code (1;1-gt�2 I
Location of proposed work 9Q0 O 1d V.,rAA CZC�
Describe fully nature of permit requested
Starting date /6 -2o O Approx.time for completion t
Call Before You Dig No.-ol o143 O 1-7 a o Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
-Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
SC-2 Gi�a p� No.cuts
0 Est.Patch Size(s) sf
Est. Pvt.Thickness in.
Est.Patch Unit Price
Est.Patch Cost$
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$
O Cash O Check#
Applicant is responsible for contacting Paid By
the Police De t.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 SOU H WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTIO TH T IS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS A O TLIN IN THE TOWN OF SOUTH WINDSOR'S STREET CUT P RMIT ANUAL.
Signed: Date: �� 2016
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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