HomeMy WebLinkAboutStreet Cut Permits 9999 Paper Chase (2) 1400049 TOWN OF SOUTH WINDSOR CT
PERMIT NUMBER ,
STREET CUT PERMIT
DATE: 04/08/2014 "
GIS ID: 69009999 "
MUNIS APPLICATION# 201400342 FEE: 25.00
EXPIRATION DATE: 04/08/2015
APPLICANT LOCATION
NAME: TELE-NETWORKS 05
ADDRESS: 9999 PAPER CHASE
ADDRESS: 31 BAKEWELL COLR Q EROW1OF SOUTH WINDSOR
CRASTON,RI 0292jf
rISLLLIVAN AVE
PHONE 401-461-8420 = = - OUTIWINDSOR,CT 060742734
311
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WORK DESCRIPTION: REPLAI✓E TINGCTV
APPLICANT AGREES TO FURNISH THITON OF 80UTH WINDSOR HE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AI�II'=EXPENSES-INCURRED BY THE TL)WI FOR=MAINTENANCE OR REPAIR WORK IN
18
CONNECTION WITH THIS PERMIT AND TIDE APPT ICANT FAMIT,IAR WITH AEI}WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH- DSIN-STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
4/8/2014 11:52 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR:
LOCATION: -Rq 9 Y a ✓i:�I
TYPE OF WORK:-,4)1ac-.�,,
DATE INSP NEEDED: DATE INSP:_
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: - -_ DATE:
W/2007 Town of South Windsor INPSEC-RON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
iTOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 060774 FEE $25.00
Name of Firm ' IV'��WOr" Phone No., V09. 84S' 2302
Address of Firm V In Zip Code Ozg0
Location of proposed work -r
Describe fully nature of permit requested V) r '-V
Starting date VJte-(e Call Before You Dig No.-)-()l I
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENTISA PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT%LD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut A Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
y� �.J� �,�l(,1„�� Est. Patch Size(s) sf
Or 1 •\ 0 Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
Est. Curb Replacement ft
Est.Curb Unit Price$ /ft
Est. Curb Cost$
Est.Sidewalk Replacement sf
1
Est. Sidewalk Unit Price$ /sf
Est.Sidewalk Cost$
i
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt. of Deposit$
Total Due$
Applicant is responsible for contacting the Police Dept. and C.B.Y.D ( ) Cash ( )Check#
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Paid By
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 FAMILIA ITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDSO5F .STRE CU PERMIT MANUAL.
a `
i''ned: — Print Name�l0L'AQ 1 V a 1A J� L t�j
Date:_
Street Excavatio Permit 2014 —