HomeMy WebLinkAboutStreet Cut Permits 130 Berle Road (2) 1200186 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/25/12
GIS ID: 10200130
FEE: 25.00
RATION DATE: 09/25/13
APPLICANT LOCATION
NAME: TELE-NETWORKS AT DRESS:` 13 ERLE ROAD
ADDRESS: 31 BAKEWELL COURT „ (} NER IONAIIUE JASON R&ANN E
CRASTON,RI 02921ills 35
EILE ROAD
SOUTH�VINDSOR,CT 06074
PHONE 401-461-8420 -21
,
WORK DESCRIPTION: INSTALLREPLAOEU ' /
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH III13xjA T3E AMOI�NT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY EPENES ING�URREI3 BYfiTE TENPGR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE ARVL4C IS FAM LIA wl- AND VII3L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN 6F SbCTH WINDSB SSTRERT CUTPRMiT MANUAL.
ISSUED BY DAB IN D INSPECTED BY
9/25/2012 11:06 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:
—A CONTRACTOR: 'l �
LOCATION:_lA t-� _Aj>0 10 i2,OOA
i .` J
TYPE OF WORK: ° �� a CA:' y
DATE INSP NEEDED: DATE INSP: 1 -30 f3
INSPECTED BY:
WORK IN
PROGRESS: _��L� �-► ®rie's %V �
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: UV\ DATE: 1 '3 - 13
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
I. No. TOWN OF SOUTH WINDSOR Permit No,
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:-9jt3hma
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm ''2 g-,)91,.>,,N Phone No.
Address of Firm —6?79 R rrrA c:�{ � Pr S ���,� � � Zip Code Q,:Rq�Z I
Location of proposed work_ 1301 .
Describe fully nature of permit requested_
Starting date 1 a Approx. time for completion
Call Before You Dig No. I�3 7� 3 3y q Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Ajaecl No.cuts
0 Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /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 THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS NED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
� J
Signed: Date:_
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