HomeMy WebLinkAboutStreet Cut Permits 50 Autumn Drive (2) 1500285 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
STREET CUT PERMIT
DATE: 12/21/2015
GIS ID: 06000050
MUNIS APPLICATION# 201501844 FEE: 25.00
EXPIRATION DATE: 12/20/2016
APPLICANT , LOCATION
NAME: TELE-NETWORKS ADDRESS: 50 AUTUMN DRIVE
ADDRESS: 31 BAKEWELL COURT OWNER: ADAMS REGINA J TRUSTEE
CRASTON,RI 02921 50 AUTUMN DRIVE
PHONE 401-461-8420
SOUTH WINDSOR,CT 06074
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 IN SPECTED BY
12/21/2015 9:59 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:; /.5�d CONTRACTOR: 1�1° , � � JG 5
LOCATION: -5-(O 64+t n �r 1
TYPE OF WORK: " s> 0 C4 /alld
DATE INSP NEEDED: DATE INSP:
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: L�"�` DATE: ^ )T J LSt
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 $25.00
Name of Firm 7eele--Ale�-Lovrks Phone No. 18 ly'?" y5"._�30'a
Address of Firm 31 ScRka,,cll C�- Cr'-Qn Sh>i f' Zip Code 09 ot,L
Location of proposed work 5 0 Ao4vAm 00v4
Describe fully nature of permit requested /pep/ace_ [�Ci`.S1-r'n�_ �AT-U/ Re,to cc,4-61!� pto
Starting date 1 - 1 9015 Call Before You Dig No o C?1550 0 P5 3 3
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: X No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
Set A� uheV/ No.cuts
0 Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price
Est.Patch Cost$
r 1 Est. Curb Replacement ft
r E=M av,Hg red
Est.Curb Unit Price$ /ft
1
Est.Curb Cost$
1
PeJ
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
WINDSOR' ST_REEV�7
RMIT MANUAL. y� C
Signe - t� Print Name �r Date:
Str t Excavati n Permit 2014