HomeMy WebLinkAboutStreet Cut Permits 38 Karen Way (2) 1500127 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 06/25/2015
GIS ID:49300038 FEE: 25.00
MUNIS APPLICATION# 201500807YPIRATION DATE: 06/24/2016
APPLICANT LOCATION
NAME: TELE-NETWORKS AbTS�E%, 3- RAN WAY
ADDRESS: 31 BAKEWELL COURIER CRTEIROBERT A&NANCY J
CRASTON,RI 02921 = 3i K-WR8N WAY
DTTI WINDSOR,CT 06074
PHONE 401-461-8420lh
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WORK DESCRIPTION: REPAA RITTNG GATV k, = /
APPLICANT AGREES TO FURNISH THE TOWI1(F SOitTH WINI�SUR T t1MDUIT OF BQ1D REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AI�I TENSES TI�ICURREI)I3Y TIIE T04iV I OR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THIAP�i CANT IS I�AIt1IIIAR WITH ANF�WILE ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SO`UT14 VVfItIDSOR' STREET CUT DER IIT MANUAL.
a 0124
ISSUE Y TED INSPECTED BY
6/25/2015 10:41 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:; A5-00/617 CONTRACTOR:
LOCATION: 3 r)a U
TYPE OF WORK: �. Ip
DATE INSP NEEDED: DATE INSP: I e
INSPECTED BY: 06
WORK IN
PROGRESS: CAT v
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT:_ �� DATE: 1
S/molloy/forms 2014 Town of South Windsor INPSEMON 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 06074 FEE $25.00
Name of Firm Tele--Ale-k,)o Irks Phone No. r 9 93— �'q5-.�3da
Address of Firm 31 Gake.cu.il C-4- Cr-a,i S+cn A 1 Zip Code O9 clg I
Location of proposed work 3�'1 /5c4rel) C.Jc,,J
Describe fully nature of permit requested /fie,a(a ac E}(s`Shn!4 CATV
Starting date_ 6 30 J-06 Call Before You Dig No 0(S26a 31�2
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: 96 No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out bV Town
two copies of separate drawing
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /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$
( )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
WINDSOR' STREET C PERMIT MANUAL. y�. c
Signe c� Print Name I"` eJ � r� Date:
Str t Excavati n Per 2014