HomeMy WebLinkAboutStreet Cut Permits 25 French Lane (2) 1500284 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 12/21/2015
GIS ID: 34450025 FEE: 25.00
MUNIS APPLICATION# 201501843 EXPIRATION DATE: 12/20/2016
APPLICANT LOCATION
NAME: TELE-NETWORKS ADDRESS: 125 FRENCH LANE
ADDRESS: 31 BAKEWELL COURT OWNER: PELES SLAVEN&AMRA
CRASTON,RI 02921 , 25 FRENCH LANE
SOUTH WINDSOR,CT 06074
PHONE 401-461-8420
WORK DESCRIPTION: REPLACE-EXISTING CATV/RELOCATING PAD
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 BY THE TOWN 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 THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
12/21/2015 9:56 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:; CONTRACTOR:
LOCATION: d S Ev-er)�, (ar\�
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 7 16-
INSPECTED BY: 3o
WORK IN
PROGRESS: S �
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C=� 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 $25.00
Name of Firm T2le rics Phone No.
Address of Firm__ 31 Bakec zil C}- Crao S+on A I Zip Code o9 99�
Location of proposed work 25 Punch Lqie
Describe fully nature of permit requested / ` ' Lg C TU 2 occ,+I 19ed
Starting date 1d'1 -)-015 Call Before You Dig No 90iS50v E37
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS, THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: 0 No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
S A.�- c,17ed
0 Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est.Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
4Mt�alk Est.Curb Cost$
P�v 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$
( )
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
WINDSOR' STREET C PERMIT MANUAL.
Signe c Print Name �we
� �� J r4 Date:
Str t Excavati n Permit 2014