HomeMy WebLinkAboutStreet Cut Permits 223 Brookfield Street (3) 1300148 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER _ _ _ _ STREET CUT PERMIT-
DATE: 06/25/2013 �
GIS ID: 14700223
FEE: 25.00
MUNIS APPLICATION# 201300874 - EXPIRATION DATE: 06/25/2014
APPLICANT LOCATION
NAME: TELE-NETWORKS �/
%��RES� ZWPBRO-OKFIELD STREET
ADDRESS: 31 BAKEWELL COULT-�
%' EI IIAC9lIARIA&AMANDIO
CRASTON RI02921
12 ZOOKFIELD ST
'mom WINDSOR, CT 06074
PHONE 401-461-8420
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WORK DESCRIPTION: REPIMOVA -L Cam/ ii�
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APPLICANT AGREES TO FURNISH THE 1WDIfdUT1�'AMQU (PND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN E1VE ;$ T H �SWN R]1AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI L AT�f s��,It�WJ I fA W ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OIL OL 3I4 WINES R fT T PF IIT MANUAL.
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ISSUED BY DATECTED INSPECTED BY
6/25/2013 11:32 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO..-_L3 bO 1�( CONTRACTOR: 1 1hOr' �
LOCATION: d
TYPE OF WORK:_ 1 � ins I I CCTV{
DATE INSP NEEDED: DATE INSP: 13
INSPECTED BY:_ - I
WORK IN
PROGRESS: e R Y -
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_6�= DATE:
S/F0PMS/TOWN OF SOUTH WINDSOR INSPECTION
s ,�-----
APPLICATION FOR STREET EXCAVATION PERMIT
o—.- --- - - - TOWN-0E-S0UTkNAANDSOP, —PermitNa
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
/ FEE $25.00
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Name of Firm /ele-Je4u,"k:S Phone No.
Address of Firm 31 ca/ C'o,s4 C cc,sfrn Zip Code G G f
Location of proposed work 9,)3- �? 9 9 S
Describe fully nature of permit requested A7,1
Starting date Approx. time for completion 1 l'�C-1
Call Before You Dig No. 0 13 2.55'cs Cl2 f � Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
0 No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /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 IS PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OU IN I E TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT NUAL.
Signed: Date: 2r � 6 (j
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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