HomeMy WebLinkAboutStreet Cut Permits 78 Old Farm Road (3) 1200025 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 03/22/12
GIS ID: 66300078
MUNIS APPLICATION# 201200290 = FEE: 25.00
E3PIRATION DATE: 03/22/13
APPLICANT ,
NAME: TELE-NETWORKS LOCATION
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ADDRESS: 31 BAKEWELL COUR RESS 78 88 GLD FARM ROAD
DER !MGEA DOREEN H
CRASTON,RI 02921 �8 CAS#ARM ROAD
PHONE 401-461-8420 - -
; �UTH VINDSOR,CT 06074
WORK DESCRIPTION: INSTAL-LFt
APPLICANT AGREES TO FURNISH THE TOWKOFSqUTITNDpT pF�pND SQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANt E PBI`ISI;S III YIR II�Y 1HJ TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI t1P3SLIANT IS IiAIIt�R WITH ANC WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OFSOL{TFjWIIDSR STIETCUTPERI�IIT MANUAL.
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ISSUED BY
DATE I I MTED INSPECTED BY
3/22/2012 10:48 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:
CONTRACTOR.—
. LOCATION:
.TYPE OF WORK:
:DATE INSP NEEDED: DATE INSP: e
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
'AS-BUILT.-
INPUT: W\-1 DATE:
W12007 Town of South Windsor INPSECiION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT �d 0004 sr
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:3'as
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm vle ye - t,)e4w or<-S Phone NoA ? L C±�- d g(;' 230 2-
Address of Firm l �'5Y��0. W �l ('0V1 G' yAce z-.L Zip Code OZ9 03
Location of proposed work ""1 — (��-0 rG�A^ 2kPl,,
Describe fully nature of permit requested 11A S" �k Ire PLOIce Cat v
Starting date 3-20_0`6 l Approx.time for completion k okas1
Call Before You Dig No-),6kc�- 2-5 9 3 Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est.Patch Cost$
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 OUTLINED THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Si Date: 3-0� ')-
itle: 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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