HomeMy WebLinkAboutStreet Cut Permits 7 Devonshire Drive (2) 1200225 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 11/07/12 /
GIS ID:27900007 = = FEE: 25.00
MUNIS APPLICATION_#_ 201201497 - XP_7R_A_TM KT n A_r_E.
A
APPLICANT /„ LOCATION
NAME: TELE-NETWORKS --ADD SS: 7b�UONSHIRE DRIVE
ADDRESS: 31 BAKEWELL COURT NEI OARIBCNI RAUL J&LYNN M
CRASTON,RI 02921 iff "SHIRE DRIVE
I AL Jam - SOJTH WINDSOR, CT 06074
PHONE 401-461-8420 =
WORK DESCRIPTION: REPLACE INT1I L OA
APPLICANT AGREES TO FURNISH THE TOWN CIF SO-IOTH WINDSORT I =AMOUNT 6 BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANC'E INAS III DEL Y IHE TflWNFOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TA APPLICANT IS IL E ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN WOUTH IND�S1Z§ST43EEI?I�JJT Is RM T MANUAL.
ISSUED BY DATE INPEPED INSPECTED BY
1 1/7/2012 1 1:05AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT N0.:10� ODoZ�� CONTRACTOR: -Y�?k- ltetzJZIrLS
LOCATION: , 7� /e '�)?oyo aS4/ rle-2
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: -2
INSPECTED BY:
WORK IN 01
PROGRESS: C; 7"1/ -.� 'lp vest
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: 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: (1 J a
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm �� -�)e't o r�s Phone No. 2rC-i f o'. L
Address of Firm a 7 MCO c P�j �C� Zip Code 0:�2ci 9, 1
Location of proposed work "I - / Ce e-j(-,/7Sh4re, cJ i'
Describe fully nature of permit requested e.� - II IZT c C'4 Tt/
Starting date / CJ I Approx. time for completion I
Call Before You Dig No. 90 1�- gSS-O 9�9S1 Existing Water Supply: ❑ Public Wat r ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
N
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
sec No.cuts
0 Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est.Patch Cost$
Est. Curb Replacement it
Est. Curb Unit Price$ /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 ED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT P�EMIT MANUAL.
Signed: Date: 4 d 12
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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