HomeMy WebLinkAboutStreet Cut Permits 9999 Clover Drive (2) 1400051 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 04/08/2014 ;
GIS ID:21609999 FEE: 25.00
MUNIS APPLICATION# 201400347 = EXPIRATION DATE: 04/08/2015
APPLICANT LOCATION
NAME: TELE-NETWORKS ADDRESS: 9999(MOVER DRIVE
ADDRESS: 31 BAKEWELL COURT-5 § OWNER TOWNF SOUTH WINDSOR
CRASTON,RI 02921 - 150tfSLLIVAN AVE
SOUTH WINDSOR,CT 060742734
PHONE 401-461-8420
WORK DESCRIPTION: REPS, E S I INCi CPiTV - /
APPLICANT AGREES TO FURNISH THTOT OF SOUTH3NUSOR�'HE"AMO-IT-QF FOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WIND SOR FOR Ak-f XEENSES-INCURIiEDBYTHE TOWN FOR 1vIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TIC APP-LICANT IS ;&LIAR WITH-AN D VIZL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN CIF SOUTH V�INDSR'-S=STREETCUT PE I`-IT MANUAL.
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ISSUED BY DAT SPECTED INSPECTED BY
4/8/2014 2:48 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:_Ycf)0,5-/ CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: 6?�
WORK IN
PROGRESS: k)Or
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: DATE: a
W/2007 Town of South Windsor INPSECTION 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 066074 FEE $25.00
Name of Firm e�Wor Phone NoA-8a 8' O p 4S. 2WZ
Address of Firm-81 Zip Code0z Q
Location of proposed work (,6 U_ L a VACAk Gt A r �10
Describe fully nature of permit requested
Starting date_Wte-1C Call Before You Dig No.;Mq 11k6 lL
3o icy i q6 i6�3c�
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut k Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
0 No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /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 STREET C T PERMIT MANUAL. (� 1n
Signe�xcavation
Print Nam D ''` ANA Date: ( �y� / l
Street rmit 2014
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