HomeMy WebLinkAboutStreet Cut Permits 1 Vibert Road (2) 1700068 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 04/11/2017
GIS ID:91800001 ,, FEE: 25.00
MUNIS APPLICATION# 201700354 K"! EXPIRATION DATE: 04/11/2018
APPLICANT` x. 'mot ' LOCATION
NAME: TELE-NETWORKS ADDRESS1IBIRT ROAD
ADDRESS: 31 BAKEWELL COURT} flWNFR SOUTIt WINDSOR TOWN OF 65
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CRASTON,RI 02921 VIBERI GOAD
} f5UTH ydINDSOR,CT 06074
PHONE 401-461-8420gg
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WORK DESCRIPTION: 1N5A,I I;1✓ !TC�SERVICE INTO TTIESWATFI_jR, RAT1IIENT FACILITY WILL
MOI 1`='CON�i7T UNpER RQAD TO TREAT MI`�ITPLANT
APPLICANT AGREES TO FURNISH TH ITOV i Z+3F OIJTH VT CI3SI I3 'RE AMC�- IT30F BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FpR AIRY EXPENSES II�tCURREIi BY 1� TOWI�I FbR,1V1AINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TE A1'PLTANT I FAMILIAR WITH AlD ILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TO MANUAL.
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ISSUED BY DATE INSPECTED INSPECTED BY
4/11/2017 8:49 AM PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO:: 0 > 3' CONTRACTOR: Ve` ,' r � -
LOCATIaN: ,
TYPE OF VIIORK:
DATE INSP NEEDED: DATE INSP: ` 7
INSPECTED
WORK IN
PROGRESS'„ j 1 r �a2- c r k t_i.; s l i , •` C' � �,,.:-� r.�...
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SEPTIC TANK PUMPED,SMASH9D,FILLED WITNESSED ❑YES ❑NO
AS BUILT:
t,, DATE
INPUT. .'
S/malloy/forms 2014 Town of So*Windsor MPSWW.WWORT 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 $25.00
Name of Firm Phone NoA�i
Address of Firm 1z-i- Zip Code_t�Z�;`
Location of proposed work (3-f r+
Describe fully nat re of permit requested v" �Z-1 1 v ����11 Cf �t t �� vi�`�'E-e
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Starting date "7 Cali Before You Dig No
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS, THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: 2--No Pavement, Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
0 No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est. Patch Unit Price$ /sf
Est. Patch Cost$
Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
Est.Curb Cost$
Est. Sidewalk Replacement sf
Est. Sidewalk Unit Price$ /sf
Est.Sidewalk Cost$
Est.Traffic Hours hr
Est.Traffic Unit Cost$ /hr
Est.Traffic Control$
Amt. of Deposit$
DRIVEWAYS must be 3ft or more from the property line per Total Due$
section 2.17 of the zoning regulations
( ) 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 ERMIT MANUAL.
Sign e L''J Print Name. A W S 0 A1VX byA Date: Z 1
Street cavatio Permit 2014
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