HomeMy WebLinkAboutStreet Cut Permits 25 Grandview Terrace 1200174 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/18/12 -
GIS ID: 37700025 FEE: 25.00
�BXPIRATION DATE: 09/18/13
APPLICANT - = _ LOCATION
NAME: TELE-NETWORKS ADTSRESS 2 GRANDVIEW TERRACE
ADDRESS: 31 BAKEWELL COURI  . OWNER MSSOi GREGORY S&MICHELLE A
CRASTON,RI 02921 25GRAI4DVIEW TERRACE
SDUT-H WINDSOR, CT 06074
PHONE 401-461-8420 -.
WORK DESCRIPTION: INSTALREE C �Vcq
APPLICANT AGREES TO FURNISH THE TOWI51 OF S TH Y&W -s?12 E ANIDUi*I�OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AAYPENSES IN.", TS7WIFORIv1VAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH1 AP'T SCANT IS FIII IAR WIT1I AND WILT ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN 6I3 SOrtI_TH WII+IDSISTREI;T`CUT PRMI T MANUAL.
ISSUED BY J DAE INPE€TED INSPECTED BY
9/18/2012 10:35 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: oo/7 CONTRACTOR:
LOCATION:
TYPE OF WORK: n S-r - �,a/�!• �Oq--`fi
DATE INSP NEEDED: `T DATE INSP:
INSPECTED BY: 13W
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: G DATE:_
S/FORMSJOWN OF SOUTH WINDSOR INSPECTION
s;
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: S` f �1h1'a-
SOUTH WINDSOR, CT 06074
1 FEE $25.00
Name of Firm 1-e ie -�'��1JJ O`� 1�S Phone No.
Address of Firm '2'12 13�6�n UJG� Pf0\1+ eoce (Ls Zip Code zliZ 1
Location of proposed work Qf4VAA0eVQ
Describe fully nature of permit requested t V1 S+,A`1 /f ee ca c@ cprkv
Starting date q 'l"- w 2 Approx.time for completion
Call Before You Dig No.'ZO tZ+5;'e 15�y o Existing Water Supply: ❑ Public Water ❑Well
370 Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
Est.Curb Replacement it
Est. Curb Unit Price
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 AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
te d: Date:
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
35
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