HomeMy WebLinkAboutStreet Cut Permits 266 Quarry Brook Driv (2) 1200178 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 09/18/12
GIS ID: 74100266
MUNIS APPLICATION# 201201213 - " " - FEE: 25.00
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APPLICANT LOCATION
NAME: TELE-NETWORKS f f DRESS 266 QUARRY BROOK DRIVE
ADDRESS: 31 BAKE WELL COURT pWNER PATELAURANG R&PRATIMABEN G
CRASTON,RI 02921
26i.`QUARRY BROOK DR
PHONE 401-461-8420 -, TIHINDSOR, CT 06074
WORK DESCRIPTION: INSATLIREPLyE CMW
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH wpMS(j1 TI4I AMD T pF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN3'IIXPEI�ISI, IN0I�JRRE�By THE T4�WN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT IS 1AMTAI WITH AND WII L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOF)TH VIrINDSR =STREE "CUT PERMIT MANUAL.
ISSUED BY DAT ECTED INSPECTED BY
9/18/2012 10:47 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: - CONTRACTOR:
LOCATION: 04
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:-
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:_
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
AOL No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT f
1540 SULLIVAN AVENUE Date: 20
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm --l2 C-jg1l'i('° Phone No. 2rc-1 f 3 0)-
Address of Firm a 7 r1cwc-G- Pr S Q<<a 9 Zip Code 0-5�<i a 1
Location of proposed work Q(6'- �.�rrrr hrrx��e (De-
Describe fully nature of permit requested (-4T tI
Starting date Approx.time for completion f7c.a
Call Before You Dig No. -90 1 X 3'70 3396 Existing Water Supply: ❑ Public Water ❑Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
see No.cuts
0�( Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /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 THA PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUT IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT ANUAL.
Signed: Date: 1 ZO 'oL
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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