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HomeMy WebLinkAboutStreet Cut Permits 7 Pepperbush Way 1200120 PERMIT NUMBER TOWN OF SOUTH W I N D S O R DATE: 07/10/12 = =_ STREET CUT PERMIT GIS ID: 70800007 MUNIS APPLICATION# 201200899 - EXPIRATION DATE: 25.00 APPLICANT - = ov10/13 NAME: TELE-NETWORKS ADDRESS: 31 BAKEWELL COUNT' : LOCATION ADDRESS;- 7 =14 PEPPERBUSH WAY CRASTON,RI 02921 DWER•- B1TTS 1EI1,A& PHONE = 71 EPPERBUSH WAY 401-461-8420 V = SOUTH VC INDSOR,CT 06074 WORK DESCRIPTION: REPLACE ftI &NG I - APPLICANT AGREES TO FURNISH THE TO- - 'THE TOWN OF SOUTH WINDSOR FOR AN ' OF CONNECTION WITH THIS PERMIT AND THUAPi�LICA WINDQR THE AMOIJI9T©F BAD REQUIRED AND TO REIMBURSE r�RRED BYE HE TOWN FDR MAINTENANCE OR REPAIR WORK IN FOR PERMITS AS OUTLINED IN THE TO NT IS FAIVII IAR WITH AIaiD WILT ABIDE BY THE RULES AND REGULATIONS TOWN OFOLITH WSR STREET,CUT PERMIT MANUAL. - ATIONS ISSUED BY DATEIN-SPE MTED 7/10/2012 10:54 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** INSPECTED BY TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: D CONTRACTOR: ele- r e—flool ks LOCATION: / TYPE OF WORK: �Q�p �,� jr ��jha C'✓��LP DATE INSP NEEDED: DATE INSP: P, Z INSPECTED BY: b WORK IN PROGRESS: L/ L-c. SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO - - ` i - INPUT: DATE: - �3 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.i n Z SOUTH WINDSOR, CT 06074 FEE $25.00 Name of Firm AC-2 g Phone No. 3t::5�2- Address of Firm ;1 el> Aa (( C rr✓,zt- (Z T Zip Code G J _ Location of proposed work_ ?-►4-1 Describe fully nature of permit requested Q�Ofcra�c ,y `Sr"r (',4T(J Starting date ;\ G Approx. time for completion 1 f� Call Before You Dig a. -CL 12 ,ACM 2 7S-- Existing Water Supply: ❑ Public ater ❑Well Existing Sewage Service: ❑ Public Sewer ❑ Septic PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR. Show sketch of proposed work or furnish This section to be filled out by two copies of separate drawing Indicate North Town of South Windsor see Gc ��c� No.cuts 0 Est. Patch Size(s) sf Est. Pvt.Thickness in. Est. Patch Unit Price$ /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$ O Cash ( ) Check# okantis responsible for contact' _ , 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 7WED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. Signed: Date:�3. 2Ct 1 ?- 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 VA, gg a 4 l±>'.• `tom., x S 'Yl -Sro+4?. },3^t '4`v. �` f' T E Cle A ar q ,. S J,I'7d 1.4 -i - V 1 replace u 1.0 �'1 Q{ Lo <b RG6 Sol c • '� a ?t3 F�' Y50o? S AID p�� ` *Wscale Scale; 1.6M5 LatkLan�_41 ®I