HomeMy WebLinkAboutStreet Cut Permits 148 Homestead Drive 1200141 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
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DATE: 08/06/12ek
GIS ID:44700148 FEE: 25.00
MUNISAPPLICATLON_#_20120-1.02.4__ _ _ > PT -ATrnN n_e7
APPLICANT =; LOCATION
NAME: TELE-NETWORKS ADDRESS 148 IIONIESTEAD DRIVE
ADDRESS: 31 BAKEWELL COURT - R RMESIMADHAVAN&SANDHYA
CRASTON,RI 02921 - ff STEAD DRIVE
S7UTH VINDSOR,CT 06074
PHONE 401-461-8420
WORK DESCRIPTION: R E P I G-I$ C R-)a W1 ING�AfTV415
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APPLICANT AGREES TO FURNISH THE TOWN OUTH VUI?SR TMOUiI OF$QND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN }?PDNE�SINtTR3YH TO�I�N FAR 1IAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH&PISLI1v'ANTIS I�AIVIII2 WITS A1�II WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOULI WINTSR STRETUPRRI4IIT MANUAL.
ISSUED BY DA' E II SPECTED INSPECTED BY
8/6/201212:45PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: l02 y i q I CONTRACTOR:
LOCATION: 14q(' 1-1--nesfe,:0 v�
TYPEOFWORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: G
WORK IN
PROGRESS: 015"`fl 2 elala��__&2 r� s
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: I ",
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:
SOUTH WINDSOR, CT 06074
1 ` EE125 O0
Name of Firm `� y N� ���5 Phone NoA'2W S)4C Z3'b2-
j'2 � ` le �1Q �C ��Address of Firm ( . &
Location of proposed work k 4 s Ao gA(1
Describe fully nature of permit requested jreVlLfACe CA—IV S@ty tc-e
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Starting date Approx.time for completion ACLA
Call Before You Dig No. Z8127(60 4�I(Q 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.
i
(4 Est. Patch Unit Price$ /sf
Est.Patch Cost$
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Est. Curb Replacement ft
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 OUT ED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signe .
Date: � -b t I Z
T tle: 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