HomeMy WebLinkAboutStreet Cut Permits 31 Autumn Drive (2) 1500233 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/08/2015
GIS ID: 06000031 FEE: 25.00
MUNIS APPLICATION# 201501420 EXPIRATION DATE: 10/07/2016
APPLICANT LOCATION
NAME: TELE-NETWORKS ADDRESS: 31 AUTUMN DRIVE
ADDRESS: 31 BAKEWELL COi1R'1 OWNER: GRODOFSKY MARSHALL P&LINDA S
CRASTON,RI 02921 31 --AUTUMN DRIVE
SOUTH WINDSOR,CT 06074
PHONE 401-461-8420
WORK DESCRIPTION: CATV
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY=EXPENSES INCURRED 13Y THE TOWI 1 FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANT IS FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN TIHE,TTpO WN OF SOUTH WI(NDSfOR'S STREET CUT PERMIT MANUAL.
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ISSUE BY 0 DATE INSPECTED INSPECTED BY
10/8/2015 2:20 PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: /ADD 6?3? CONTRACTOR:_1e%-
LOCATION: 31 14 wtW m ,cl Pl i V-e-
TYPE OF WORK: Gg-ry .
DATE INSP NEEDED: DATE INSP: 116 /4
INSPECTED BY: n
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: 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, CT 06074 FEE $25.00
Name of Firm Tele-le-4-�o rk S Phone No, /S �'� ys �30'a
Address of Firm 31 8ctkeL,, II C-- C(-Qt) S+cn A( Zip Code
Location of proposed work 3/- yy Aj fi(lMn br
Describe fully nature of permit requested Pep/ace, C5U-Shn�l C( I U
Starting date "1S Call Before You Dig No aofS 39G/563
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWNS CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: 10 No Pavement, Curb of Sidewa►k Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
' 0Est. Patch Size(s) sf
C Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est.Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
Est.Curb Cost$
Est. Sidewalk Replacement sf
,• tcra
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
WINDSOR'S,STREET C PERMIT MANUAL.
1�
Signe ��-• Print Name �r� eS � J r� Date:
Str t Excavati n Permit 2014