HomeMy WebLinkAboutStreet Cut Permits 37 Hearthstone Drive (2) 1300195 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER -STREET CUT PERMIT
DATE: 07/30/2013
GIS ID:41100037 FEE: 25.00
MUNIS APPLICATION# 201301069 EIRATION DATE: 07/30/2014
APPLICANT „ ;LOCATION
NAME: TELE-NETWORKSed Sf 37 H1 AR-HSTONE DRIVE
ADDRESS: 31 BAKEWELL COUKT 100- GITTLEI N ALAN L&DONNA T
CRASTON,RI 02921 = = 37 HaktHSTONE DRIV
= UTI WNDSOR, CT 06074
PHONE 401-461-8420
WORK DESCRIPTION: REPLY E Y-S— G
APPLICANT AGREES TO FURNISH THE Tf WNk0F SOUTH` DSf31 TH PMOvg- OF BOLD REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AMI- ENSESANC N FOR Nf-A TENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE API ICANT jS FI4Al�WI TF ANI WT1 ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED
�I`N1THE TOWN OF SOUTH tWINNR' TREET GU PERMIT MANUAL. /� d
ISSUED BY DATEINSPECTED INSPECTED BY
7/30/2013 8:54 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 13e)o I q,5- CONTRACTOR: l'-e)e- k)dwgr K
LOCATION: 3
TYPE OF WORK: Zev a.CP
DATE INSP NEEDED: DATE INSP: 12 -_�0 13
INSPECTED BY: '
WORK IN
PROGRESS: %Jv
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: /,( DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Dates- 13
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm �F�£"�lli�_�6110 Flkj Phone No. Y%y
Address of Firm 3 1 Cox. _r" Jn,1 Z Zip Code 094 I
Location of proposed work 37- 5 2 4eajitj ()(—
Describe fully nature of permit requested 2E jec,'/?C ,' CA-1 V
Starting date `"Qq 3a Approx. time for completion 1 (�c.
Call Before You Dig No.201 3 Existing Water Supply: ❑ Public Vlater ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
No.cuts0 ee_ 11
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /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 ED N THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: +T� �
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
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