HomeMy WebLinkAboutStreet Cut Permits 521 Quarry Brook Driv (2) 1400292 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 09/30/2014
GIS ID: 74100521 FEE: 25.00
MUNIS APPLICATION# 201401382 RXPIRATION DATE: 09/30/2015
APPLICANT-
LOCATION
NAME: TELE-NETWORKS ADDRESS: 521 51 QUARRY BROOK DRIVE
ADDRESS: 31 BAKEWELL COUR OWNER: TQRFF LAWRENCE E&JANE B
CRASTON,RI 02921 = - 521 QUARRY BROOK DR
SOUTH VYINDSOR,CT 06074
PHONE 401-461-8420
WORK DESCRIPTION: REPLACE EXISTING CATV
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WINDSOR THE AMOUNT OF B6h1D 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 THE APPLICANT IS FAMILIAR WITH AND WILLABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PElm T MANUAL.
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ISSUED BY D�AIT INSPECTED INSPECTED BY
9/30/2014 11:09 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: -fe/e- ti 0Oz It
LOCATION: UaftW 'RAdok 0�6 y--e.
TYPE OF WORK: I ek S'1'1
DATE INSP NEEDED: DATE INSP: 1 /3 l
INSPECTED BY:
WORK IN
PROGRESS: iqt--e
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED [:] YES ❑ NO
AS-BUILT:
s
INPUT: L�� 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 Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CTo06074 FEE $25.00
Name of Firm Te�P -� wot�S PhoneNo. 34G-2302
Address of Firmd'1J 6CO aLkw LkAd C0 V l C,P C!Z r— Zip Code 3
Location of proposed work S2I -SSI Cd(,acr ybcrovl(pr 1'7 Scj)/ r
Describe fully nature of permit requested Y--ePUA -e x`S+k n 6i CAT V
Starting date 7- p- I q Call Before You Dig Noa6I�L 590,231 -ate IV3 90 J- 3 7
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: JR No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
® Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out bV Town
two copies of separate drawing ' Q�n
seeaC" �c�1 No.cuts
0 Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
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 TREE T PERMIT MANUAL. y V�(/�{�/� (�
Signe : Print NamQ(( � '✓' "' `��`� Date: �'� J�/
reet Excavation Permit 2014
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