HomeMy WebLinkAboutStreet Cut Permits 11 Partridge Lane (3) 1300053 TOWN OF SOUTH WI
PERMIT NUMBER N D S O R, C T
STREET CUT PERMIT
DATE: 04/15/2013
GIS ID: 69600011
MUS APPLICATION# 201300439 FEE:
M M-PIRATION DATE: 25.00
04/15/2014
APPLICANTx _
NAME: s % �%� i LOCATION
I —Am �DRE�
TELE-NETWORKS
ADDRESS: 31 BAKEWELL COU1 _ �� � 1 f PART--RIDGE LANE
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CRASTON,RI 02921 % E PAREN`I MATTHEW A&AILISA A
-0-PDTI-IDGE LANE
PHONE % JTII V1INDSOR, CT 06074
401-461-8420 ---
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WORK DESCRIPTION:
REPLAC-O-En f����
APPLICANT AGREES TO FURNISH THE! WbtR OU '
THE TOWN OF SOUTH WINDSOR FOR AN O, -SOU1T.' � Q ID REQUIRED AND TO REIMBURSE
CONNECTION WITH THIS PERMIT AND THL�IILjrwc� T IS / 1 OR MAINTENANCE OR REPAIR WORK IN
FOR PERMITS AS OUTLINED IN THE TOWN 01LI WIST WIC QPE ABIDE BY THE RULES AND REGULATIONS
_ RT MANUAL.
ISSUED BYzlj�1
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INSPECTED BY
4/15/20133:00PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: C CONTRACTOR:
LOCATION: I i .. a
TYPE OF WORK: , exi
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DATE INSP NEEDED: DATE INSP: S�aaI�3
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
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:
SOUTH WINDSOR, CT 06074
(( FEE $25.00
Name of Firm -fElc �11M or-kS Phone No. 3 o 9
Address of Firm 31 (6--k-o we d c4 Or-f�r?s4n n Zip Code d 9-c('Z I
Location of proposed work 11-a;? aar,�r,da-e
Describe fully nature of permit requested (Z�(2IGc,11ic, CA-T V
Starting date y / ;go I Approx. time for completion i oc"!
Call Before You Dig No.,;Q 13 16100 70 P- Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
PT,c4e4 No.cuts
0 Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$ /it
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 E IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: cylt I 1 .3
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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