HomeMy WebLinkAboutStreet Cut Permits 46 Tumble Brook Drive (2) 1600011 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 03/17/2016
GIS ID: 90600046 FEE: 25.00
MUNIS APPLICATION# 201600250 EXPIRATION DATE: 03/17/2017
APPLICANT LOCATION
NAME: TELE-NETWORKS ADDRESS: 46 TUMBLE BROOK DRIVE
ADDRESS: 31 BAKEWELL COURT OWNER: JACKSON DAVID&SUSAN
CRASTON,RI 02921 = 46 TUMBLE BROOK DR
--SOUTH---- INDSOR,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 ANY-EXPENSES INCURRED BY THE TOWN-FOR-MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE APPLICANTI�AMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOLT INDSOR'S STREET CUT PERMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECT BY
3/17/2016 9:41 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: /(coo CONTRACTOR:
k
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: 1 11w
INSPECTED BY:
WORK IN
PROGRESS:
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
AS-BUILT:
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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 $25.00
Name of Firm 7,fle-A/e4-c,,>v r k S Phone No. [9 23— �3 �
Address of Firm 31 13ctkec.L it CL s k A l Zip Code
Location of proposed work W +^-6k brcuk 0--
Describe fully nature of permit requested Pcahice i (AT/
Starting date 1-16 Call Before You Dig No -2 016 !<U 21 S-�
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: ❑ No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
0 No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
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�STREET C PERMIT MANUAL.
Signe Print Name J r` Date:
Stre t Excavati n Permit 2014
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File Edit Billing Seances Customerinformation OrderEntryr PPV Frtancraf `HrstoryHSQHe[p
JCOMS .' .I1/ 3fi d al: f ...
Acct Nbr 467325-03 Task
Exit DAVID JACKSON Co/Dv/Frn 51 10 426 Cust Info
Prt W/O 46 Tumblebrook Dr Phone# Home 860 989-3090
View 2 South Windsor, CT 06074-2217 Bus Tech# 0
Exit and Petain Q Code 0 BURY DROP Job Seq
Priority 5 Pool J Job Nbr 000 Tag Nbr 460780
Work Order Number 20554772 Problem Code
Svcs Work Order Type SR special Request Addtl Problem Codes
Stage History Work Order Status Not Coded Primary Finding .
Time Slots Dispatch Comment r Primary Solution .
Prorates Work Order Comments JF42 Pri LocTech Flash sw2
Sch Date 5/15/16 Sec Loc
Comments Sch Time ALLDYI Node ID 3ND05
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