HomeMy WebLinkAboutStreet Cut Permits 42 Wentworth Drive s
1000242 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 12/07/10
GIS ID: 93300042 FEE: 25.00
MUNIS APPLICATION# 201001650 EXPIRATION DATE: 12/07/11
,
APPLICANT = — — LOCATION
NAME: TELE—NETWORKS yfr RESS 42 WENTWORTH DRIVE
ADDRESS: 31 BAKEWELL COURT OWI R: I YA- PE�tRIE I&
CRASTON,RI 02921 42UETWORTH DRIVE
" DUTH WINDSOR,CT 06074
PHONE 401-461-8420
WORK DESCRIPTION: REPLAC G LXISTING CATV
APPLICANT AGREES TO FURNISH THE TOWN_OF SOUTH 1�IDSOR-T' AMOUNT.-OF-BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY=EXP hISES NCUR"-W YTREJ, OWN FOR_-MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE AI'1'L"I AN f IS,_FAMILIAR)AffTH ANIS WI1 L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOU TH WIN i S�TREES'CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
12n/20101:58PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
.........................
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: Cad CONTRACTOR: r e
LOCATION:_ y Q
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:_►
INSPECTED BY: �
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
�0 )0 01 (050 APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm ���_ c O rle-c, Phone No.
Address of Firm 3 i It -f C Zip Code096i L l
Location of proposed work
Describe fully nature of permit requested CATU
Starting date Approx.time for completion 1
Call Before You Dig No.-2010 (4 q c)�a6 9 Existing Water Supply: ❑ Public Wat r ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
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$
( )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 A O TLIN D HE TOWN OF SOUTH WINDSOR'S STREET CUT PE MIT MANUAL.
Signed: Date:
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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