HomeMy WebLinkAboutStreet Cut Permits 35 Cadbury (3) 1200110 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/20/12 ;
GIS ID: 15900035 %'- % FEE: 25.00
MUNIS APPLICATION# 201200807
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APPLICANT Z LOCATION
NAME: TELE-NETWORKS � �� �DRES 3 DURY
ADDRESS: 31 BAKEWELL COuf = �/ F
s R ATHOMAS R&LISA M
CRASTON,RI 02921> -1 � �% - -Z Ai
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1 INDSOR,CT 06074
PHONE 401-461-8420 -
WORK DESCRIPTION: REPI� V� �,INIMV-6 �
APPLICANT AGREES TO FURNISH THE'YWF (�UTj; � (U �� D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN E wSm - -- - INTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH 1P1�Iy �4fil Iv W I-A wil ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN 01OLTVR� I RBf C PELT MANUAL.
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ISSUED BY IDAf9 TED INSPECTED BY
6/21/2012 8:51 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMESij
***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: In?M CONTRACTOR: I el-wO .c
LOCATION:
TYPE OF WORK: �i0 Ir c i oa� ��r iS�1 n c CA-rU
DATE INSP NEEDED: DATE INSP: i t
INSPECTED BY: r3.t>
WORK IN
PROGRESS: -boK e &ad yo. s 2Ps r�
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: —" DATE: /0-
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: 1 9L0Ia
SOUTH WINDSOR, CT 06074
Name of Firm ale 'Vdoor-ks Phone No. �°�� ��l� c 33 a
Address of Firm i ► i e 11 c4: (2ran54ct-i -V—:� Zip Code 0961a �
Location of proposed work 35-- SO Cc now In/
Describe fully nature of permit requested C. otgt 1R, ems &( cksj
Starting date ;1-O OId2 Approx.time for completion t
Call Before You Dig No. LO) u6 � '1 Existing Water Supply: ❑ Public�&Wt
ter. �OW�e I l
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
cs e� &J— No.cuts
0� G{/` 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.
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 WI HIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS I D IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT 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
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