HomeMy WebLinkAboutStreet Cut Permits 97 Country View Drive (2) 1400304
PERMIT NUMBER TOWN OF SOUTH W
INDSOR CT
DATE: 10/06/2014 _ STREET CUT PENT
GIS ID:24300097
MUNIS APPLICATION# 201401420
-
FEE:
APPLI
PIRATION DATE: 25.00
NAME: TELE-N TWORKS NT _ = 10/06/2015
ADDRESS: 31 BAKEWELL COUR-ffT;, - L OCATIO ADDRESS: �7=98O
CRASTON,RI 02921 _ - UNTRY VIEW DRIVE
� IVEI � LIKENDAVID W
PHONE 401-461-8420 - = C�UrRY VIEW DR
}ITH WINDSOR, CT 06074
WORK DESCRIPTION: REPLAN EXSTIN C -
-
APPLICANT AGREES TO FURNISH THE -
THE TOWN OF SOUTH WINDSOR FOR ANY E POEN 0 S IhZ -
CONNECTION WITH THIS PE 11*IT1R4R GOOF BCVD RE FOR PERMITS AS OUTLINED IN THE TO THR APPT LCANT IS ERRED BY THE TOJAR
WIT- VIi FO AINTEN�gN OR UIRED AND TO REIMBURSE
WN OFSOUTH WII IDSORIS STTE'T CU R_III MANUAL. REPAIR WORK IN
ABWILL
IDE BY THE RULES AND REGULATIONS
ISSUE By �G� G �, 1 /
10i6i2014 11:12 AM DATE INSPECID
INSPECTED
*** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 14100,30Y CONTRACTOR:_kh- /1
LOCATION: 7- 9 r
TYPE OF WORK:--crDhme
DATE INSP NEEDED: DATE INSP: s'
INSPECTED BY:_ p
WORK IN
PROGRESS:_
`j
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES [:] NO
AS-BUILT:
INPUT: V" DATE:
S/molloy/forms 2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 Permit .0
�l � FEE $25.00
o.
Name of Firm - ew oc-�S
Phone No
Address of Firm'-1� 5co .'
(��O CU✓1 C!z �1 Zip Code OZ9U3
Location of proposed work q7 �tK c0c,n�-� ,� (� �f aL2 .. �Al��,.
Describe fully nature of permit requested I VAce -e X CA T V
Starting date__ IU,-3 g Call Before You Dig No':46 1
Yc��i r-,sty!
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
f Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by Town
seeac �
No.cuts
Est. Patch Size(s) sf
0 Est. Pvt. Thickness in.
Est. Patch Unit Price$__/sf
Est. Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$_----/ft
Est. Curb Cost$
Est. Sidewalk Replacement sf
Est. Sidewalk Unit Price$ /sf
Est. Sidewalk Cost$
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 FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH
WINDSOR's TREET C PERMIT MANUAL. �,/� V��n u�I_
Signe w �u/ Print Name�l�ly\ �✓I"��Y `''J �G1
reet Excavation Permit 2014
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