HomeMy WebLinkAboutStreet Cut Permits 18 Welles Lane (2) 1300201 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 07/30/2013 =
GIS ID: 92900018 FEE: 25.00
MUNIS APPLICATION# 201301075 - - EXPIRATION DATE: 07/30/2014
APPLICANT = '" /
LOCATION
NAME: TELE-NETWORKS la
�DDRES 18 WEL ,ES LANE
ADDRESS: 31 BAKEWELL COUIf-fi DER SA GJEMEI&
CRASTON,RI 02921 1 = "It8"yLS LANE
NOY = SJUTI VC INDSOR,CT 06074
PHONE 401-461-8420 ,
WORK DESCRIPTION: REP
Zip
APPLICANT AGREES TO FURNISH THE T1WL�F (1UTH=VNDB � MOZIi ( B(1ID REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FO D VITIHl TOWN F9R I1 AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TH LANT IS WIl,T ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED INTHE TO OUTHVIN1BSR S TREL ".CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
7/30/2013 9:14 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 13 00 901 CONTRACTOR: Te-l e - A_ W0�' L5
LOCATION: IS we i l yes La u%e
TYPE OF WORK: ('e la6e A T V
DATE INSP NEEDED: DATE INSP: y— /
INSPECTED BY:
WORK IN
PROGRESS: , S
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: Ltv-1 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 Date:
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm ��� �'�t�- �,1C)rlC3 Phone No. 7'6'f' 3 o 9
Address of Firm c n�c�,�S �'t TZ y Zip Code 09—ct rz I
Location of proposed work /ISS- / [ ,00e5 -U
Describe fully nature of permit requested CA-T V
Starting date _ yIv 3O� 2C("5 Approx. time for completion I
Call Before You Dig No.,�01 3 300 30�,.3 Existing Water Supply: ❑ Public Water ❑ Well
Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH, TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
5ee 4-6 +h,d No.cuts
0 Est. Patch Size(s) sf
Est. Pvt. Thickness in.
Est. Patch Unit Price$ /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 OUT IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: - Date: �U� 2 S PoG
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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