HomeMy WebLinkAboutStreet Cut Permits 52 Hearthstone Drive (3) 1,400143 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/03/2014
GIS ID:41100052 FEE: 25.00
MUNIS APPLICATION# 201400693 EXPIRATION DATE: 06/03/2015
APPLICANT LOCATION
NAME: TELE-NETWORKS J, ADDRESS: S�HEARTHSTONE DRIVE
ADDRESS: 31 BAKEWELL COUNT OWNER: BRAMIAVAR DEEPAK M&PURNIMA
CRASTON,RI 0292 52IEATHSTONE DRIV
SOUTH-iVNDSOR, CT 06074
PHONE 401-461-8420 -
WORK DESCRIPTION: REFLA IMSTING CATV /
APPLICANT AGREES TO FURNISH TH&OWI OF SOUTH WINDSOR THE AMO-ON OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A1*IIXPENSES INCURRED-BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT IS FAMILIAR WITH AND V-1--LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSR'S STREET CUT PERMIT MANUAL.
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ISSUED BY DATE INSPECTED INSPECTED BY
6/3/2014 8:48 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:�L CONTRACTOR: IWC _ ki0_7 X (rS
LOCATION: _ — ����. Gar`t -one ,fir 1 U e
TYPE OF WORK: 1_e 2 r
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: im
WORK IN
PROGRESS: l e Je NelooA- s hepl ce J �Ex<sA C,4r-v bi,-�e
J
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C DATE:
S/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, CT 0�6+0774 FEE $25.00
Name of Firm ' iv'� Wor Phone NO ga 0' M. tzwz
Address of Firm V v\ e- Ka Zip Codev2QQ
Location of proposed work `j 2 5 t� R-eckc•kA-) S'Aroq< of
Describe fully nature of permit requested 1 -e (:-'( -e'M VAff (`AFN
Starting date `�3 2,-1 ?�4 Call Before You Dig Noantq
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT CQU D BE LATER THAN A YEAR.
/0GSSt`91
Check Applicable: ❑ No Pavement,Curb or Sidewalk Cut M Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out bV Town
two copies of separate drawing
See �C6eC( No.cuts
0 Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est. Patch Cost$
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
WINDSORATREATUTPERMIT.MANUAL.E ""�� �,��A/n� j� nSignedPrint Name`1am03 1/ Nm yyJ Date:
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