HomeMy WebLinkAboutStreet Cut Permits 27 Bramblebrae (2) 1400120 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/20/2014
GIS ID: 12600027 - FEE: 25.00
MUNIS APPLICATION it201400600 EXPIRATION DATE: OS/20/2015
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APPLICAIf LOCATION
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NAME: TELE-NETWORKS f3MMBLEBRAE
ADDRESS: 31 BAKEWELL COL$ ����
)�E kLLISON D&CHRISTOPHER A
CRASTON,RI 0292glo _ BRAIBLEBRAE
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S ar WINDSOR, CT 06074
PHONE 401-46 8 . : "
WORK DESCRIPTION: INSTAMN- -
THE DRAIN LAYER ASSIGNED TO THI PI&T S A UPI -ISSU 3 E TH1 "STATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FORIfiN IIETRACJ � DITI}Iai I CORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WIND SOR,STANDA A MBIIS AND FEE ATTACHED CONDITIONS.
ISSUED BY 5/20/2014 9:28 AM DAT INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: CONTRACTOR: /-P)� _ Al etli- �1C
LOCATION: `� f� )yl���o�►
TYPE OF WORK: j 6G. neo CAT
DATE INSP NEEDED: DATE INSP: 17 !_�
INSPECTED BY:
WORK IN
PROGRESS: 7-'It AT V
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
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INPUT: v v DATE:
S/2014 Town of South Windsor INPSECfION REPORT 14
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APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00
Name of Firm ��1`►�' ^off- S Phone No. 21�0
Address of Firm i;`•iiG,6 Zip Code Z��03
Location of proposed work 97-al d 6s e
Describe fully nature of permit requested i 11�' �`l r('(> � CH T V
Starting date 510,1 A01 y Call Before You Dig No 1 qo 3'7oLl
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: IN No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out bV Town
two copies of separate drawing
0 No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
Est.Curb Replacement ft
Est.Curb Unit Price$ /ft
Est.Curb Cost$
Est. Sidewalk Replacement sf
Est. Sidewalk Unit Price
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt. of Deposit$
Total Due$
( ) Cash ( )Check#
Applicant is responsible for contacting the Police Dept.and C.B.Y.D
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
WINDSO 'S STREET, PERMIT MANUAL. j r 11 L,
Sianad`` �`^ Print Name�ayy e S' '�, � 1� ` C\ Date:
Creet Excavatio Permit 2014
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