HomeMy WebLinkAboutStreet Cut Permits 73 Wood Pond Road (2) 1200147 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 08/20/12
GIS ID: 96000073 _ FEE: 25.00
.0
_ VIRATION DATE: 08/20/13
APPLICANT LOCATION
NAME: TELE-NETWORKS It-
ADDRESS 73-WOOL?POND ROAD
ADDRESS: 31 BAKEWELL COURT - C R` T VERN R GERALD R JR&DEBORAH A
NO
CRASTON,RI 02921 JAY = 73 w POND ROAD
V.
BUT WINDSOR,CT 06074
PHONE 401-461-8420 -
WORK DESCRIPTION: INSTALL
APPLICANT AGREES TO FURNISH THE TQ;WN C1F SOUTH,WNII4R T AMOUIV OP BAND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY- 3 PEI SES -NCft $Y H T�3 -N F-OR 1�1AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE AP IGANT IS FAMTITAR�V11H AIxll WILT ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SPUTTII WIIUTSSR S TREE UT ERIy1'- MANUAL.
ISSUED BY DATrNpV TED INSPECTED B
8/20/2012 10:51 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I R o o I g i CONTRACTOR: 1;� le, 1 e7W_W/,,pS
LOCATION:_"] 3 W DC.d Pond l C ack
TYPE OF WORK: ,t
DATE INSP NEEDED: DATE INSP: I"
INSPECTED BY:
WORK IN
PROGRESS: C' -�1� � „�`�ce� �' � �/�i' ,�e� ✓
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
SJFORMS/TOWN OF SOUTH WINDSOR INSPECTION
_ APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
Name of Firm A0 WY\CC 0 C or'�,;T E%Mee(M( � Phone No.SLb_ r3 l'
Address of Firm S C l SI n' )T 12� Zip Code
Location of proposed work
Describe fully nature of permit requested V STD
Starting date o Approx. time for completions
Call Before You Dig No. Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
- Est. Patch Unit Price$ /sf
Est. Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
^—� f Est. Curb Cost$
Est. Traffic Unit Cost$ /hr
Est.Traffic Control $
Arnt.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 5WITH THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS A OU INED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed:
Date: t? (7
Title: Driver's License#: 54 5
PLEASE ALLOW AT LEAST TWO WORKING DAYS AFTER APPLICATION FOR ISSUANCE OF PERMIT
JORK MAY NOT BEGIN UNTIL A PERMIT HAS BEEN ISSUED
IT SHALL BE KEPT ON JOBSITE AT ALL TIMES i
Permit 08 REV 10-22-08