HomeMy WebLinkAboutStreet Cut Permits 165 West Road ----------------------
1000214 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/07/10
GIS ID: 93600165 FEE: 25.00
MUNIS APPLICATION# 201001372 - EXPIRATION DATE: 10/07/11
APPLICAN = -= LOCATION
NAME: TELE-NETWORKS  ADDRESS: 16S WEST ROAD
ADDRESS: 31 BAKEWELL COURT dWER KRIICKAS ALBERT D
CRASTON,RI 02921 - - = - ; 165 WEST ROAD
- = OUT =WINDSOR,CT 06074
PHONE 401-461-8420
WORK DESCRIPTION: REPLAC G E- IS'��NG-CATV
APPLICANT AGREES TO FURNISH THE TC WN fl-F SOUTH WINDSOR TEE AMOUNT OPBOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYV&ENSES 1NCURRED;BY,THE TOWN FORIVTAINTENANCE OR REPAIR WORK IN
AP
CONNECTION WITH THIS PERMIT AND THE PLICAI�IT"IB FAMILIAR WI`i�f3 AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOI.JTH WINDSR S.�TRF,ET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
10/7/201011:13AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
.. ........
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: / (900,1 CONTRACTOR: 1'e je- /()CLkJDrr <<'
LOCATION: I 0 S W PV �Q
TYPE OF WORK: IDy,nl a c 0a A- j (14 rt�J
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:��
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:�I
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:jQ1,1.1261a
SOUTH WINDSOR,CT 06074
, FEE $25.00
Name of Firm -rev-NPk In[ks Phone No. /'g g<K. ju
Address of Firm St S,—k ec lg=, 1 1 Cl-. CC6416-f3„ R Z Zip Code
Location of proposed work "t'/6S (JeSj 1ZQ
Describe fully nature of permit requested Q��cs.�r: �r �n� C A 7"tl
Starting date Approx.time for completion i `�.►
Call Before You Dig No. 2G/D Uoa 3 Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
o copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est.Patch Sizes) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est.Patch Cost$
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 ITH THIS ERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS LINED IJ rHE TOWN OF SOUTH WINDSOR'S STREET CUT P IT MANUAL.
Signed: Date-Z �?O
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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