HomeMy WebLinkAboutStreet Cut Permits 11 Partridge Lane (2) 1100165 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/17/11
GIS ID: 69600011 =" FEE: 25.00
MUNIS APPLICATION# 201101212 = EXPIRATION DATE: 10/16/12
APPLICANT LOCATION
NAME: TELE-NETWORKS ADDRESS: 1l PARTRIDGE LANE
ADDRESS: 272 BROADWAY C}W1ER: PARENTS MATTHEW A&AILISA A
PROVIDENCE,RI 02903 11 PARTRIDGE LANE
" " SOIJI WINDSOR,CT 06074
PHONE
WORK DESCRIPTION: INSTALL RBPI ?.CE CCTV"
APPLICANT AGREES TO FURNISH THE TQWI AF OUTH=Wl-NDSOR AMOUNT-OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANI'E (PIvNSES INC'f7F3? Y THE"TOW --FOR. AINTENANCE OR REPAIR WORK IN"
CONNECTION WITH THIS PERMIT AND THE AP I_CANT IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OTi�QUTHVINDSR S STREET CtJT,PERMIT MANUAL.
ISSUED BY DATEINSPECTED INSPECTED BY
10/17/201110:50AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
............- _ ........................... --
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.. - L DO/ ` = CONTRACTOR: /� �✓
LOCATION:_ jI 1,?r_;LiCf/4 ZQhe
TYPE OF WORK:_ ('A
DATE INSP NEEDED: DATE INSP: 6 k zli z
INSPECTED BY: 3
WORK IN
PROGRESS:__, r
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
'AS-BUILT:
INPUT. DATE:
W12007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: 0 \2 t
SOUTH WINDSOR, CT 06074
t r FEE $25.00
.l Name of Firm e" N�e-�wq(y-S Phone No. S g�' S(ACI- Z- 0 2-
Address of Firm al a- W(5QAWQUU A F(OU\CJ 0- nL12 R-1 Zip Code 01CW 3
Location of proposed work A e1Z k Q CAP (-N
Describe fully nature of permit requested k A +(k I C V
Starting date 10- \-I. 2,0 l ( Approx.time for completion
Call Before You Dig No.a6 k k L0,6 11 k 3 Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
0
Est. Patch Size(s) sf
Est.Pvt.Thickness in.
Est. Patch Unit Price$ /sf
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.
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 T D THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
tnec o_ Date:
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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