HomeMy WebLinkAboutStreet Cut Permits 12 Darlene Drive 1600044 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/02/2016
GIS ID:25500012 FEE: 25.00
MUNIS APPLICATION# 201600520 f iXPIRATION DATE: 05/02/2017
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APPLICANT' LOCATION
NAME: TELE-NETWORKS ill- ENE' , DRIVE
ADDRESS: 31 BAKEWELL COL�`RI r ` OVNEk GOOD7IN MICHAEL B&CAROL I,
CRASTON,RI 02921` +' ' ,;' ' 1 -410
ARI.ENE DRIVE
Y� =SOUTH WINDSOR,CT 06074
PHONE 401-461-8420 3
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WORK DESCRIPTION: CAV���4 ; t 1 i Y
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APPLICANT AGREES TO FURNISH THg `Oy'-�1 F SOUIET 1 sS THI AMQUNTzOF OND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR A1s,1Y`INP&S"ES MTIR,'U- BY��IE TQ1�I*�FOIE MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND TI 'PLICANT ISM FAMILIAR WTI i # i WIT L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN�7F,SOUT.W1NDS C}Tt':.3:STR111 F GUT PERMIT MANUAL.
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ISSUED BY DATE INSPECTED INSPE TED BY
5/2/2016 11:49 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDS01"INSPECTION REPORT
PERMIT NO.: eug Ov CONTRACTOR:�;7� i ^ /V�'' ✓ 17
LOCATION: /d Aa ,C L Q e a) UY� ---
TYPE OF WORK:— ' " 7
DATE INSP NEEDED: DATE INSP:'
INSPECTED BY: �'
WORK IN
PROGRESS:
SEPTIC TANK PUMPED,SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
INPUT: _ l" DATE:,
S/moitoy/forms 2014 Town of South Windsor ImPSEcmoh 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 06C0�.74 FEE $25.00
Name of Firm Phone No. �' 8U8 '84 Z
G" 3o2
Address of Firm k13 5 \tJ_ PAt'K S T. c ov 1 ck�em cie y2T Zip Code O 2-9 0 9
Location of proposed work I2 oar Pyi-E' or,
Describe fully nature of permit requested C(N CA %Y,l S+1 In C(Al v
Starting date Call Before You Dig No '?- l0 \\g 4�
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT IS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS, THE PERMANENT PATCH 1S
TYPICALLY COMPLETED WITHIN A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: 0 No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes ❑ Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
see No.cuts
0 Est. Patch Size(s) sf
Est.Pvt.Thickness in.
Est. Patch Unit Price
Est.Patch Cost$
Est. Curb Replacement ft
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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$
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
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 S EET C PERMIT MANUAL.
Sign e Print Name S Date: _ Z a
Stree xcavation Permit 2014
.File .diti Billing Seruices CustomerIaformatinn Order Entry pPV Finant�al Hi`sta.ry` FiSD Neip`
Acct Nbr 487415-01
Task
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Nichael Goodwin CofDv/Frn 51 10 426 Cost Info
• 12 Darlene Dr Phone# Home 860 648-0770
South Vindsor, CT 06074-2855 Bus 860 277-2057 Tech# 0
�iit and Per !t
6� `I t0+ �+ E} Q Code 0 BURY DROP Job Seq
on 6
Priority 5 Pool J Job Nbr 000 Tag Nbr 1518968
kats Work Order Number 20651153 Problem Code
I gives Work Order Type SR special Request Addtl Problem Codes
i�fage History
Work Order Status Not Coded Primary Finding .
Time Slots Dispatch Comment Primary Solution .
Work Order Comments jr42 Pri Loc SV4
Sch Date 5/15/16 Sec Lac
[Tech Flash
Sch Time ALLDYl Node ID SUD07
Ckin Usr Stage
Cat Occ Service From To Amount
C 1 WGDROP UG DROPWK 1 ' .'00 67859 JSIREKo
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