HomeMy WebLinkAboutStreet Cut Permits 340 Brookfield Street (2) 1500224 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 09/28/2015
GIS ID: 14700340
MUNIS APPLICATION# 201501355 FEE: 25.00
EXPIRATION DATE: 09/27/2016
APPLICANT LOCATION
NAME: TELE-NETWORKS ADDRESS: 340 B1 OOKFIELD STREET ADDRESS: 31 BAKEWELL COURT,' OWNER: PAAY THOMAS J&SUSAN E
CRASTON,RI 0292I 57
340:BROOKFIELD ST
PHONE 401-461-8420 = SOU - WINDSOR,CT 06074
WORK DESCRIPTION: CATU =
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A14IYEX PEN SES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TIC APPLICANT IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO WN QF SOUTH WINDSQR'S STREET CUT PERMIT MANUAL.
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ISSUED BY DATE INSPECTED INSPECTED BY
9/28/2015 2:27 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO..: 1.5100 CONTRACTOR: to/E'-lUe�'/,clr f Ks
LOCATION: J'qD &ookAelr) S-rrr-e`L
TYPE OF WORK: CAW
DATE INSP NEEDED: DATE INSP: I�
INSPECTED BY: �d
WORK IN
PROGRESS:_ s�e'"
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: _ DATE:
S/molloy/forms 2014 Town of South Windsor INPSECflON 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 $25.00
Name of Firm Phone No,
Address of Firm 31 8cLkec�z11 C}- Cr-can S h:n ja 1 Zip Code CP9
Location of proposed work 3 9`0 13 r-c e j(F,`ej d S.-
Describe fully nature of permit requested Pce/ce
Starting date q-ja-IS Call Before You Dig No
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: X No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
0 No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
3q 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
t ti
r led 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'S,STREET C PERMIT MANUAL.
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SigntExca
Print Name r �� Date:
Str t, n Permit 2014