HomeMy WebLinkAboutStreet Cut Permits 166 Rosemary Lane (2) 1200224 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 11/07/12
GIS ID: 77400166 =- =
MUNIS APPLICATIOI�L# 20.1.2�14. FEE: 25.0096 '° � _
_ _ -
_ ATION DATE: 11/07/13
APPLICANT
NAME: TELE-NETWORKS LOCATION
ADDRESS: 31 BAKEWELL COUNT ADDRE , I66-RO1$EMARY LANE
CRASTON,RI 02921 / EANDA ,IONEL A&SANDRA
- SMARY LANE
00-UTH*INDSOR,CT 06074
PHONE 401-461 $420
WORK DESCRIPTION: INSTALIrREPLAAff
T �
THE DRAIN LAYER ASSIGNED TO THIS PERM-1 I�AS A VA�I�yIC N .SSUEI}gyTHE STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORTi IN�I�1 ALTAII3I #7TIONS t,ALL WaRK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDARDS,All C7SIIA R �LIZMENI`S Al TIIE ATTACHED CONDITIONS.
ISSUED Y DATE INSPECTED INSPECTED BY
1 1/7/2012 1 1:03 AM
/v
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: / WOO CONTRACTOR:
LOCATION: y�
TYPE OF WORK: v
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS: i C I< r- �J
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: Z 13
S/FORMS(TOWN OF SOUM WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: J�
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm Cam( _,t/��( 1To/ Phone No. `J �.
Address of Firm 979 r-gcc Zip Code O:2--a�Z I
Location of proposed work IAJ
Describe fully nature of permit requested C h Tt/
Starting date // moo+ Approx.time for completion I t�Ci ,f
Call Before You Dig No. Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A,
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
see- ��� � No.cuts
0 Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /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 THIS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUT D IN THE TOWN OF SOUTH WINDSOR'S STREET CUT P�7�7d
UAL.
Signed: Date: 0 I
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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