HomeMy WebLinkAboutStreet Cut Permits 533 Quarry Brook Driv (2) 1300147 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET-CUT PERMIT
DATE: 06/25/2013 UMN ;
GIS ID: 74100533 FEE: 25.00
MUNIS APPLICATION# 201300872 % EXPIRATION DATE: 06/25/2014
%%
APPLICANWOW
IV = LOCATION
NAME: TELE-NETWORKS REA 533'QUARRY BROOK DRIVE
ADDRESS: 31 BAKEWELL COUI I OkSINI I EITH T&SUSAN M
CRASTON,RI 02921
-3i ON RY BROOK DR
iLJTW VINDSOR,CT 06074
PHONE 401-461-8420
WORK DESCRIPTION: REPLA INS L
APPLICANT AGREES TO FURNISH THE I )W � OUTIT F 1 AMO CIF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN SS I1O�I&A� TI1 T4WN�OR AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THIS IJAC. ITIS RA I�W��AI WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN PE RdT MANUAL.
ISSUED BY DATE ED INSPECTED BY
6/25/2013 11:23 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: d_ 1 q 7 CONTRACTOR: �,�Je . te r
LOCATION: 5
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: i - 3- 3
INSPECTED BY:
WORK IN
PROGRESS: 1
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: -( DATE:
S/FORMS/TOWN OF SOUTH WINDSOR INSPECTION
APPLICATION FOR STREET EXCAVATION PERMIT
-AppL No. - - -_ TOWN OF SOUTH WINDSOR------ - - --P-ermrt-No. ---
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date: t c�
SOUTH WINDSOR, CT 06074
/ f FEE $25.00
Name of Firm '���. e,?C�c1r" Phone No. `6`ZS' �t a
Address of Firm 3f lore 11 c rc TZ--T- Zip Code 0_4.e/P 1
Location of proposed work S3 3- S-(-/ / 6 oczr-c-i brc- dr-
Describe fully nature of permit requested CAT,/
Starting date Approx. time for completion f
Call Before You Dig No.a0(3 c/,,),ogf Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA,CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish
two copies of separate drawing This section to be filled out by
Indicate North Town of South Windsor
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
Est.Curb Replacement ft
Est. Curb Unit Price$ /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 I, D IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL,
Signed: Date:- P013
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