HomeMy WebLinkAboutStreet Cut Permits 9999 Buckland Road 1600171 -
TOWN OF SOUTH WINDSOR, CT
PERM-TT—NUMBER —
STREET CUT PERMIT
DATE: 09/02/2016
GIS ID: 15309999 FEE;MUNIS APPLICATION# 201601191 25A0
GE,XPIRATION DATE: 09/02/2017
25.00
APPLICANT
LOCATION
NAME: TELE-NETWORKS ti ` Y ADDRESS �C1I ,AND ROAD
ADDRESS: 31 BAKEWELL COLJ4`F '� OWNER SOUTI .WINDSOR TOWN OF
CRASTON,RI 02ki cz 1 „- t
�r �1Sd0 SU,LIVAN AVE
SOUTH1VINDSOR CT 06074
PHONE 40I-461-8420 s 4 5 > <.:�r s '
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WORK DESCRIPTION: INS�AL P7CrrCbNDIT?TRp1Vp ?�#6 dTO= OWFt SUPPLY LOCATED
1NS)Q�Fa rU` RI . AIL OR 130
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APPLICANT AGREES TO FURNISH THE'TO I QFOUTIwW,IN1j2SCE°AMpI Ii�IOF BLIND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR Ah1 =E1 CPL`NS�$$ C`"7RRI`UYS IqE T(�jrW F{�R;MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND This.4I�I�Lr w T ISI AI IA 2 WI`1I I AI�[D W�LZ ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN`O SO;tJ>?H WINL�SOI2° STI CIJ 1 pIRMIT MANUAL.
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ISSUED B ]SATE INS ECED
INSPECTED BY
9/2/2016 11:31 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NOi: I CONTRACTOR:
LOCATION: 'l .
TYPE OF WORK: 1 O 2 e A ' ` S '
DATE INSP NEEDED: DATE INSP:
INSPECTED BY: CD
WORK IN ,
PROGRESS: 22111 h-542 1 14
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑YES ❑ NO
AS-BUILT:
.
INPUT:
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S/mofloyffirms 2014 Town of south Windsor INPSECtION REPORT 14
APPLICATION FOR STREET EXCAVATION PERMIT
Appl. No. TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No.
T l TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074 FEE $25.00
Name of Firm Ne ll Wocv—'S Phone No
Address of Firm l�+s W , Pat;IK—' ';+- PrOv 1d-e+1Ce (2,T Zip CodeOZLl 0
Location of proposed work uccuand1 CA, �ZQ' e'AS}- ov� ".4"an Ce -fib Uy-c9(ee►'1 wkl k"'
Describe fully nature of permit requested n S 4-&I k I.P4 C 4f0I1dLV k+ Ql`^ �'�lQ (o �DWe{'
Starting date 'C�l Call Before You Dig No
PLEASE NOTE: THE DEPOSIT FOR THE PERMANENT PAVEMENT PATCH AND CURB REPLACEMENT IS A PRELIMINARY ESTIMATE. THE
APPLICANT iS RESPONSIBLE FOR THE FULL FINAL COST OF THE PERMANENT PATCH AND CURB REPLACEMENT,INCLUDING ANY
INCREASES IN PATCH AREA,CURB LENGTH,TRAFFIC CONTROL AND THE TOWN'S CONTRACT COSTS. THE PERMANENT PATCH IS
TYPICALLY COMPLETED WITHIN� A YEAR OF THE TEMPORARY PATCH BUT IT COULD BE LATER THAN A YEAR.
Check Applicable: IJ No Pavement,Curb or Sidewalk Cut ❑ Pavement Cut ❑ Curb Cut ❑ Sidewalk Cut
❑ Existing Driveway, No Changes O Proposed Driveway Widening ❑ Proposed New Driveway
Water Supply: ❑ Public Water ❑ Well Sewage Service: ❑ Public Sewer ❑ Septic
Show sketch of proposed work or furnish Indicate North This section to be filled out by Town
two copies of separate drawing
No.cuts
Est. Patch Size(s) sf
Est. Pvt.Thickness in.
Est, Patch Unit Price$ /sf
Est.Patch Cost$
\ Est. Curb Replacement ft
Est. Curb Unit Price$ /ft
Est.Curb Cost$
NEst. Sidewalk Replacement sf
t, Est. Sidewalk Unit Price
Est.Sidewalk Cost$
(A"COCk AVe 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.S.Y.D
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES Paid By
i
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 RMIT MANUAL. �,
Signed: ew PrintNamel�� ��fV` V+ -- Date:
Stre Excavatio Permit 2014