HomeMy WebLinkAboutStreet Cut Permits 104 Gilbert Lane (2) 1600014 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 03/17/2016
GIS ID: 35300104 FEE: 25.00
MUNIS APPLICATION# 201600253 EXPIRATION DATE: 03/17/2017
APPLICANT LOCATION
NAME: TELE-NETWORKS ADDRESS: 1,104 GILBERT LANE
ADDRESS: 31 BAKEWELL COURT OWNER: SAPOWADIA KETAN&REKHABEN
CRASTON,RI 02921 104 GILERT LANE
SOUTH WINDSOR, CT 06074
PHONE 401-461-8420
WORK DESCRIPTION: REPLACE EXISTING CATV
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTH-WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANYEXPENSES 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 WINDS R'S STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
3/17/2016 9:49 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT No;: 16 CONTRACTOR: ���2K4 S
LOCATION:
TYPE OF WORK: T�. 4 ,47-V
DATE INSP NEEDED: DATE INSP:✓Z• S`v/�
INSPECTED BY: 1`A�
WORK IN .
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: DATE:
S/molloy/forms 2014 Town of South Windsor INPSEC I ION 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 $25.00
Name of Firm -Ale -�y rk s Phone No. I� �'�' M-111 3Ga
Address of Firm 31 &LkeL,,_.II C�- C,-ctn S Fci A I Zip Code a;�
Location of proposed work 10'1-i l$ 6,.f btr+I-n
Describe fully nature of permit requested Pcj2/ace [--5Us »!� CATV
Starting date Call Before You Dig No o/6/Go 3S f y
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: li'& 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
A�-�cr.���c1
0 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
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,STREE iT CC PERMIT MANUAL. l /
Signe �J� U Print Name �tpJ Date: '3-446
Stre t Excavati n Permit 2014
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