HomeMy WebLinkAboutStreet Cut Permits 37 Paper Chase (2) 1300051 TOWN OF SOUTH WINDSOR CT
PERMIT NUMBER ,
,,- STREET CUT PERMIT
DATE: 04/15/2013
GIS ID: 69000017
MUNIS APPLICATION# 201300437 ��'�� A& FEE:
25.00
LPIRATION DATE:
�� m - 04/15/2014
APPLICANT %
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APPLICANT
-NETWORKS % ���
ADDRESS: 31 BAKEWELL COU % D PAPER CHASE
CRASTON,RI 02921
ift !� E RQN40N GARY L®INA S
Ek CHASE
PHONE 401-461-8420 INDSOR,CT 06074
WORK DESCRIPTION:
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APPLICANT AGREES TO FURNISH THE 1Wg-
THEP SOUTH �� J
TOWN OF SOUTH WINDSOR FOR AN _ = Q BAND REQUIRED AND TO REIMBURSE
CONNECTION WITH THIS PERMIT AND TH T R MAINTENANCE OR REPAIR WORK IN
LAIT IS � A ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OI 0UT wm
C�PELT MANUAL.
o 1719
ISSUED BY DAT E IN -TED
INSPECTED BY
4/15/2013 2:36 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: QQ2 CONTRACTOR:
LOCATION: q•5„ a a
TYPE OF WORK: .
DATE INSP NEEDED: DATE INSP: 9 /
INSPECTED BY:
WORK IN
PROGRESS: 1�a
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE:
_�Jjqlj ,
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: i 1
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm -felc Je-L)c)c1<3 Phone No. ' `SCl s` �30�
Address of Firm 31 Ga ko cJe-0 C4 0aXf7cA-t Zip Code 09-6t 2 1
Location of proposed work //— 13 AcAe r c s e
Describe fully nature of permit requested f�eplez '/tc, E'x�'S ¢�'�rcr CA-T V
Starting date r 2v►3 Approx. time for completion
Call Before You Dig No.20 1 3 1 4-100 70 1 Existing Water Supply: ❑ Public Wafer ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
see No. cuts
0 Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /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 OUTL EDP THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
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
REPN
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