HomeMy WebLinkAboutStreet Cut Permits 326 Quarry Brook Driv (2) 1200227 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 11/07/12
GIS ID: 74100326
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MUNIS APPLICATION# 201201499 = EXPIRATION DATE: 11/07/13
APPLICANT - J LOCATION
NAME: TELE-NETWORKS
JV AD �E�S: 26 QiARRY BROOK DRIVE
ADDRESS: 31 BAKEWELL COUfT( 1 MANEE EY CRAIG S&LISA M
CRASTON,RI 02921 �� �% �5 L�U-RRy BROOK DR
S-0 TH WINDSOR, CT 06074
PHONE 401-461-8420Am
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WORK DESCRIPTION: INST L ly. ��
10
APPLICANT AGREES TO FURNISH THE TOWN OF 0 TH W DSO TM&AMOI T OF BOND REQUIRED AND TO REIMBURSE
�%
THE TOWN OF SOUTH WINDSOR FOR AN 1 TENSES INO�I�R.E`I�RFgHE TS3WN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI;ARPLICANT IS lyl�I I AI WIT I AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOI TH W-fNDSR S STREI I C�JT PER11I T MANUAL.
10
ISSUED BY INSPECTED BY
I1/7/201211:14AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 7 CONTRACTOR: 50
LOCATION:
6
TYPE OF WORK: �S
DATE INSP NEEDED: DATE INSP: 13
INSPECTED BY: t3)
WORK IN
PROGRESS:_ 4'T V L s r�� a�•d r �e�l
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: G DATE: �Z
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
FEE $25.00
Name of Firm ''%lg_ Phone No. $5; `-1 o,�;-
Address of Firm 9 7 rICC C -T Zip Code 0,--R g I
Location of proposed work 3_Z C, -- 5-0 +IG?Ja r-c- ► 1�)C)k or-
Describe fully nature of permit requested_ e`.� ; I! ��iZT C� (4TIJ
Starting date / C: ( Approx. time for completion I /
Call Before You Dig No. -9G i —0 -0 25 Existing Water Supply: ❑ Public Vlater ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Sec No.cuts
0 Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /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 O D IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PER IT ANUAL.
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
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