HomeMy WebLinkAboutDrain Layers Permit 124 Brookfield Stree a -TOW OF SOUTH WINDSOR INSPECTION REPORT
Permit No.
Contractor COX COMMUNICATIONS
LoE ,x ,Qg LUB HSEAddress 801 PARKER ST.
MANCHESTER,CT
06040 CT 06040 �I
o No. (860)432-5211
Date Insp Needed I /
Time Insp Needed
_ I
Inspected By
1
Work in Progress
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Date
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Permit No. 3365
Date - 08/07/2002 Town of South Windsor, CT '
Street Excavation Permit
Expiration Date 08/07/2003
Descrip: INSTALL CATV LINE AT CLUB HOUSE i
3
Applicant
Location
a
Name COX COMMUNICATIONS W GOLF COURSE CLUB HSE
Addr. 801 PARKER ST.
06040 CT 06040 - CABLE
Phone (860)432-5211
Applicant agree
Wi dsor the amount of bond
required and to rei ut for any expenses
incurred by the To me rep in connection with this
permit and that app abide by the rules and
regulations for per u outh Windsor's Street
Cut Permit Manual . 3
* * PERMIT ALL TIMES.
Issued by 0 �D
e
Date Completed 7 �� Inspected By
nug 07 02 08: 16a Witch Ent. Utility Div 4130210955 P. 1
APPLICATION FOR STREET EXCAVATION PERMIT
�S .. TOWN OF SOUTH WINDSOR ?j
PUBLIC WORKS DEPARTMENT
a TOWN HALL
O t� 1540 SULLIVAN AVENUE
A SOUTH WINDSOR, CT
FEE 25
Name of Firm 4�GGrsr� +� 1C C"lb Phone No. J&0 -Sta "
Address of Firm
proposed ,Lr� �QQr=A t
Location of ro osed work
Describe fully nature of permit requested �- &-1 C
Starting date ,v Approx.time for completion (-_ `., W I.&K er I Fin tr7
Call Before You Dig No. Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
No.cuts
Amt. of Deposit$ by
5 S� ( )Cash c)Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town $
Applicant is responsible for contacting by date
the Police Dept. and C.B.Y.D.
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 CONNECT ION 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 CUT PERMIT MANUAL.
Signed: � n"''� - Date:
Title: D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
Aug 07 02 08: 16a Witch Ent. Utility Div 4138210955 X. p. 2
..
Mass: 008-344.7233
Fx 781-721.0047 DIG SAFE 2002 3 200056 CLEARS 8/$ 7:00
Mass ID#17930 NUMBER ON
AM
Conn!800-922-4455
Fx 203 248-6448
Contractor#1167 CITY f000�-4DATEl� 1
STREET
ADDRESS
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-CHANGE IF DIFFERENT CATV WORK
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AREA MARKED ? YES
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