HomeMy WebLinkAboutStreet Cut Permits 125 Cambridge drive 1200175 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/18/12
GIS ID: 16200125 = FEE: 25.00
MUNIS APPLICATION# 201201209 ,=; _ f I'PIRATION DATE: no/i
APPLICANT LOCATION
NAME: TELE-NETWORKSff
AT��T5�2ES"S: SAYIBRIDGE DRIVE
ADDRESS: 31 BAKEWELL COURT �1ER— LJ QICNG
CRASTON,RI 0292112A1IBRIDGE DRIVE
Qjj- -Hl WINDSOR, CT 06074
PHONE 401-461-8420ty
;=
WORK DESCRIPTION: INST�ILLREPLA'CE
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH VINISfi TFJE AMpU1IT pF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANC'ftg SES IN 'I113R1 b 3Y BET" I 6R MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THfv APPLICA-NT IS MMILIAI WITI4 AND WILT ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOr}TH WINDSR S STYE I G�JT I'ERIYII MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
9/18/2012 10:37 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:, — CONTRACTOR: �°f t°' /I moll" 5
LOCATION:
TYPE OF WORK: l tiS ►�t"D1C(C� Ci4`7'
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: T'y
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ (' AIN"_ DATE:
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:2l� "ZG,
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm �2 E'-,'Jat o(-ks Phone No. 555 7s 2r445-, -�n'9-
Address of Firm 9 7 -Cr-,-J 01 IPrO V<J PIX e Zip Code _ I
Location of proposed work /aS C �*-IbJQP C,—
Describe fully nature of perm I IZTr,n C4Ttj
Starting date / Zd Approx. time for completion
Call Before You Dig No. G I a- 0 3(-j 6 a-- Existing Water Supply: ❑ Public W ter ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
see- 6 No.cuts
0(�( Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /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$
( ) 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 IS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OU D IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: ( Z '-
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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