HomeMy WebLinkAboutStreet Cut Permits 63 Wood Pond Road (3) 1400190 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 06/30/2014
GIS ID: 96000063 =
MUNIS APPLICATION# 201400868 FEE: 25.00
EXPIRATION DATE: 06/30/2015
20
APPLIC
LOCATION
NAME: TELE-NETWORKS ADDRSVO D POND ROAD
ADDRESS: 31 BAKEWELL COIR' ,
CRASTON,RI 0292K
HA STAM WALTER E II&MARILYN M
",
D6D POND ROAD
111`0 INDSOR, CT 06074
PHONE 401-461-8420 -
WORK DESCRIPTION: REIiff
fi4TFf��C�AT
APPLICANT AGREES TO FURNISH AN
THMITO J OF SOIFTI-L I�ID I I AMQ NrT V I3#�ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A Y:R�PEN§ES
A -V- F -WA_ 'OIZ��CIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TF1 A P�,IANT IA1�IfLAR WIH AI4ji�LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN(3 SOUT3T DSR� R RT J TI'E IIT MANUAL.
ISSUED BY DATE SPtCTED '''
INSPECTED BY
6/30/2014 10:55 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: ���I CI jJ CONTRACTOR: �� o ® S
LOCATION: fo.� W OOd 190P,5W
TYPE OF WORK: `
DATE INSP NEEDED: DATE INSP: •i i�'
INSPECTED BY: +fib
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:- DATE:
S/2014 Town of South Windsor INPSEMON REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
1540 SULLIVAN AVENUE Date:
SOUTH WINDSOR, CT 06074
� jj l FEE $25.00
Name of Firm Phone No.99.
Address of Firmal, Zip Code
Location of proposed work 63- 9 0 ' U000deolvi6t
Describe fully nature of permit requested Y- e(A(--e PY-L .4-"V1 G-, C'Ac-X V
Starting date Approx.time for completion Wo+C i9H y S
Call Before You Dig No. 1 8 2 Z(e-0 i\89 Existing Water Supply: ❑ Public Water ❑Well
J(00 t Existing Sewage Service: ❑ Public Sewer ❑ Septic
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A
PRELIMINARY ESTIMATE. THE APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE
PERMANENT PATCH AND CURB REPLACEMENT, INCLUDING ANY INCREASES IN PATCH AREA, CURB
LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS TYPICALLY
COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
,See cVie
No.cuts
0
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /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 OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Sig rie
a.c Date: (o��K l C(
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
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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